3 About the Health Bucks Evaluation Tool Kit Purpose of the Health Bucks Evaluation Tool Kit This tool kit was created to assist farmers market incentive programs in designing and implementing evaluations. The provided tools can be adapted for incentive programs of various sizes, and can be scaled to guide both small and large evaluations. This tool kit uses the New York City Health Bucks program as an example, providing evaluation tools, sample evaluation questions, and recommendations/lessons learned. In response to the growing prevalence of obesity in the United States, the Division of Nutrition, Physical Activity, and Obesity (DNPAO) at the Centers for Disease Control and Prevention (CDC) is working to reduce obesity and its related health conditions via a multi-pronged approach including active identification of promising local programs and policies designed to prevent obesity. Priority is being given to those programs and policies targeting improved eating habits and physical activity levels in low-income communities (CDC 2009). In keeping with this broad set of objectives, the CDC contracted with Abt Associates Inc. in 2009 to perform an evaluation of the NYC Health Bucks Program., The New York City Health Bucks program distributes coupons good for the purchase of fresh fruits and vegetables at farmers markets to Food Stamp/ Supplemental Nutrition Assistance Programs (SNAP) participants and other low-income residents of underserved New York City neighborhoods. During the final stage of the NYC Health Bucks evaluation, findings from this evaluation were used develop a how-to-manual/tool kit that provides practical guidelines on program evaluation. For more information on the New York City Health Bucks program, visit the Center of Excellence for Training and Research Translation website. How to Use the Health Bucks Evaluation Tool Kit This tool kit provides a step-by-step guide to conducting a sound evaluation, with a particular focus on evaluation of farmers market incentive programs. The first section, Checklist of Basic Evaluation Steps, serves as an introduction to evaluation and presents a framework for evaluating incentive programs. Section two provides a Summary of the Health Bucks Program Evaluation, and focuses specifically on the Health Bucks program and details process and outcome evaluation measures. The third section, Program Evaluation: Techniques and Tools, outlines best practices for data collection, and includes a library of tools used in the Health Bucks evaluation such as sample surveys, interview guides, and consent protocols. The fourth and final section, Dissemination of Findings: How to Share Results, describes general dissemination guidelines and details lessons learned for program evaluation implementation. 1 1 A list of web addresses for links supplied in this document can be found on page 26. Health Bucks Evaluation Toolkit pg. 1

5 Checklist of Basic Evaluation Steps This section provides a basic step-by-step guide to conducting an evaluation of a farmers market incentive program. The Centers for Disease Control and Prevention (CDC) Framework for Program Evaluation in Public Health (1999) was employed to a) identify barriers and facilitators to implementation of the NYC Health Bucks program and b) to assess overall effectiveness of the program at the community and individual level, in order to improve on the existing program model and to inform other organizations wishing to implement similar interventions. The following evaluation checklist, adapted from the CDC Framework i (Exhibit 1), will assist you and your evaluation team in following the essential steps for program evaluation in public health systems. Step 1: Engage Stakeholders At the beginning of your evaluation make sure to include those involved in program operations, those served or affected by the program, and primary users of the evaluation. ii Why Should You Engage Stakeholders in Your Evaluation? To understand how the program works from a variety of perspectives To ensure your evaluation accurately assesses goals and expected outcomes of the program, and addresses the interests and concerns of all involved parties To obtain input on your proposed design and evaluation strategy To assist with data gathering and refinement of data collection approaches To support you and your evaluation team in analyzing, interpreting, and disseminating your findings How Should You Engage Stakeholders in Your Evaluation? The level and type of engagement will vary depending on the specific goals of your evaluation. Examples of soliciting input and feedback from key stakeholders may include informal communications such as or phone conversations, formal in-person or telephone interviews, self-administered web and/or written surveys, or focus group discussions. Ideally, stakeholders engaged may include: Staff involved in program administration and implementation National, State and/or local officials Health Bucks Evaluation Toolkit pg. 3

6 Participating community organizations Researchers and organizations with experience conducting similar evaluations Farmers market owner/operators, managers, farmers, and vendors Those served or affected by the program (i.e., farmers market shoppers, residents of neighborhoods near farmers markets, participants in WIC (Women, Infants, and Children), SNAP (Supplemental Nutrition Assistance Program) and other nutrition/food programs, and other groups. Evaluation Tip Engage stakeholders at all levels. Building partnerships with multiple stakeholders is critical for program success. Needed partners will vary but may include vendors, health clinics, community residents, communitybased organizations, universities, local policy makers, and other organizations. Step 2: Describe the Program Describing components of the program such as its context, mission, resources, target populations, expected activities and outcomes, and success criteria will prepare you for designing the evaluation (described in Step 3). It might be helpful to describe the following program characteristics: Summarize the problem or issue that the program addresses and describe the broad environmental context in which the program operates. For example, in neighborhoods targeted by the Health Bucks program, poor nutritional knowledge and behaviors are coupled with significant financial and geographical barriers to accessing healthful foods such as fruits and vegetables, contributing to high overall obesity rates and health disparities among area children and adolescents. Understanding the setting and environmental context of the program will ultimately influence your evaluation design, data collection methods and tools, and assist you and your team in interpreting your findings. Using a social ecological approach that considers all the factors (e.g., levels of nutritional knowledge, geographic barriers, cost of food, etc.) that are associated with obesity rates and health disparities is important in designing the program and the evaluation. Describe the program s mission and goals. Outline program activities and create a timeline for each activity. Health Bucks Evaluation Toolkit pg. 4

7 Program activities might include recruiting farmers markets and community organizations to distribute incentives, community outreach/promotional activities, collecting and reimbursing farmers markets for redeemed incentive coupons, nutrition education for consumers. Identify community resources (i.e., financial, staff expertise, technology, tools) that are needed to conduct program activities. Detail program outcomes. Think about outcomes at both the individual and community level. For example: An individual-level outcome would be an increase in frequency or number of people shopping at local farmers markets. A community-level outcome would be an increase in the number of farmers markets in underserved areas. Also consider varying timeframes; your program might target short-term, intermediate, and long-term outcomes. Short-term outcomes might include: Increasing the number of farmers markets and vendors participating in your program, accepting SNAP benefits, or using wireless EBT technology, and increasing awareness of the program among local residents. Intermediate outcomes might include: Increasing the number of farmers markets operating in local neighborhoods, improving the amount, quality, and variety of produce offered by vendors at farmers markets, and increasing nutritional knowledge, purchase, and consumption of fresh fruits and vegetables among targeted populations. Long-term outcomes might include: Improving overall dietary quality, reducing child and adult obesity rates, and reducing nutritional disparities. Use your program description to develop a program logic model (see page 27 for an example of the Health Bucks Logic Model) as a tool for planning and evaluation of ongoing activities. A logic model describes program inputs (e.g., resources), outputs (e.g., activities), expected outcomes (short, intermediate and long-term) and assumptions or external factors that may influence program results. Developing a comprehensive logic model can help you to identify key process and outcome questions for your evaluation. There are many good tips for creating a useful logic model posted online; CDC s Healthier Workplace Initiative Logic Model page or CDC s Developing and Using a Logic Model Evaluation Guide page are good places to start. Evaluation Tip Ensure comprehensive understanding of program operations before designing and implementing your evaluation. The activities in Steps 2 and 3 will help you accomplish this. Health Bucks Evaluation Toolkit pg. 5

8 Step 3: Focus Evaluation Design A comprehensive and systematic evaluation design is beneficial to both stakeholders and the evaluation team. CDC states that a thorough evaluation plan creates an evaluation strategy with the greatest chance of being useful, feasible, ethical, and accurate. The following are recommended steps in designing your evaluation: Think about the goals of your evaluation: what are you trying to achieve? Possible motivations might be program improvement, stakeholder engagement, or demonstration of program success for potential funders or others who may wish to expand or implement similar programs. An evaluation may serve any or all of these purposes, but clearly defining your goals from the start will help to guide your overall design. Obtain information on other similar evaluations already conducted or in process, and consider whether any components of their evaluation design may be incorporated into your own. Identify evaluation questions and methods (see Program Evaluation: Techniques and Tools for additional information about research methods). Identify appropriate respondent groups for the evaluation. Individuals, groups, or organizations involved in program implementation Individuals, groups, or organizations targeted by the intervention Other program stakeholders as identified in Step 1 above as appropriate Consider whether there is a group of respondents not associated with or targeted by the program who could serve as a comparison or control group Determine what is feasible within the time and resources available for conducting the evaluation. Identify with whom the evaluation findings will be shared, as this may help determine the format of your dissemination products (see Step 6 for details). Evaluation Tip Engagement of all stakeholders during the evaluation design process will ensure that evaluation questions and the evaluation design are appropriate for the target audience(s) and feasible within the allotted resources.. Health Bucks Evaluation Toolkit pg. 6

9 Step 4: Gather Credible Evidence Once the evaluation design has been determined, the data collection tools and processes can be developed. Initial formative conversations with key stakeholders will help guide the development of data collection instruments and evaluation activities (e.g., interviews, surveys, etc.), which will be used to gather substantive information about the program. Choose data collection methods that will generate different types of information, (e.g., qualitative and quantitative), and allow for input from various sources. For more information about the benefits and drawbacks of different types of data collection methods, refer to the Program Evaluation: Techniques and Tools section. Identify existing data sources Administrative data or records already collected by the program Local survey data collected on an ongoing basis for outcomes of interest Develop data collection protocols and instruments Consent forms, interview and moderator guides, training materials Protocols for interviews, focus groups, and observations and site visits Surveys and observation forms Develop an analysis plan summarizing how you will use the data you collect to answer evaluation questions. Engage key stakeholders in analysis plan development to ensure the approach meets their needs and to obtain sign-off on all aspects of design and analysis. If needed, obtain necessary approvals for data collection, such as IRB approval Collect your data Identify the appropriate time frame for data collection from each group. (Which groups should be surveyed first? Will there be a baseline data collection phase? At what points during and after the program should data be collected?) Consider resources, including recruitment and training of data collection staff, as well as analytic capabilities Develop recruitment strategies Recruit participants or respondents Analyze the data collected from a variety of sources Specific analysis methods will depend on the type of data and the needs of the evaluation Relatively simple analytic approaches may be appropriate if results are primarily intended for internal use and/or for non-technical audiences. Health Bucks Evaluation Toolkit pg. 7

10 If findings will be disseminated more widely, particularly to more technical audiences like academics or policymakers who require rigorous evidence of impacts on outcomes, more sophisticated analytic techniques may be required. Keep your analytic goals and capabilities in mind from the outset when designing data collection instruments and tools. This will prevent wasting limited resources on data that will not ultimately be useful in the analysis phase. Qualitative analysis methods may include summarizing key themes or findings from interviews or focus groups, or more sophisticated analysis techniques using qualitative analysis software such as Nvivo or ATLAS.ti. Quantitative analysis methods may include simple descriptive tables and charts with results from surveys or observations, or more complex statistical analyses to make comparisons between different subpopulations and/or over time using statistical software such as SAS, Stata, or SPSS. Consider whether a partnership or contract with an external entity, such as a university or state department/ agency with expertise in complex data analysis, may be helpful. Evaluation Tip Do not underestimate time and level of effort for human subjects research (i.e., Institutional Review Board -IRB) paperwork, evaluation plan clearance), or other review requirements specific to your organization. The level and type of review needed will depend on the evaluation funding source, objectives (e.g., program improvement vs. generalizable research), publication plans, and data sources. Be sure to comply with all local review requirements, and build flexibility into the data collection timeline in case of unanticipated holdups. Step 5: Justify Your Conclusions After data collection and analysis is complete, interpret your findings into meaningful results for your target audience(s). The following tips may help translate the findings into practical recommendations. Work towards a consensus of all key stakeholders concerning their expectations: Will everyone apply the same criteria for assessing a program s performance? Be aware that not everyone defines success in the same way. Does everyone agree on how to examine, summarize, and interpret evaluation data? Health Bucks Evaluation Toolkit pg. 8

11 Formulate conclusions based on evidence gathered and judged against agreed-upon standards set by stakeholders. It s best to agree on this in advance, and write up an analysis plan that everyone agrees you will stick to later on (see Step 4). If the evaluation shows meaningful results, create recommendations based on the findings and the broader context in which the program operates. The broader context could include different target audiences, fiscal considerations, the physical environment, program operations, and policy issues. Results do not necessarily need to show a program was successful for the results to be meaningful. For example, redirecting program implementation efforts can provide valuable information to program staff and key stakeholders, and can ultimately lead to programmatic and evaluation improvements. See Step 6 for examples of how to formulate recommendations appropriate for a variety of target audiences. Evaluation Tip Ensuring the independence of evaluators can help to avoid bias or the appearance of bias in your results. When possible, evaluation teams should be led by and/or include individuals who would not be affected by evaluation results to support the credibility of the results. Step 6: Share Lessons Learned Sharing all the details about the evaluation (e.g., design, processes, findings, and recommendations) helps to assure that the evaluation findings are used, disseminated appropriately and adapted to similar programs. Strategies for sharing lessons learned include the following: Communicate your findings with the community and stakeholder organizations. Inform program funders about evaluation and policy implications of evaluation results. Consider wider dissemination who else might benefit from your lessons learned? Evaluation Tip Close the feedback loop make sure to share your evaluation results with all respondent groups and stakeholders. Health Bucks Evaluation Toolkit pg. 9

12 Summary of Health Bucks Program Evaluation Abt Associates, Inc., a research company, was contracted by the Centers for Disease Control and Prevention (CDC) to evaluate the New York City Health Bucks program, a farmers market incentive program that provides $2 coupons for low-income individuals and families in three District Public Health Offices (DPHO) areas to purchase fresh fruits and vegetables at farmers markets. To learn more about the Health Bucks program, click here to visit the Health Bucks Overview page on the Center of Excellence for Training and Research Translation website. The evaluation design was derived from the CDC Framework for Program Evaluation for Public Health, and incorporated CDC s four groups of standards: utility, feasibility, propriety, and accuracy. iii It was highly collaborative and consisted of two separate components serving distinct purposes: a process evaluation and an outcome evaluation. Both components used qualitative and quantitative methods (focus groups, key informant interviews, and surveys) to collect data from farmers market consumers, market vendors and managers, participating community organizations, and program administrators. Process Evaluation The purpose of the process evaluation was two-fold: (1) to identify barriers and facilitators to implementation of the Health Bucks program, in order to improve on the existing program model, and (2) to collect information for organizations wishing to implement similar interventions. The process evaluation included a formative phase to assist the evaluation team in understanding the Health Bucks program and an evaluative phase to assess lessons learned. It also documented the evolution of the program, including early lessons learned, and documented facilitators and barriers to program implementation. Stakeholder participation from the initial phases of the evaluation was key to its success as it helped foster engagement and investment, contributing to a fuller understanding of the program among the evaluation team. See Exhibit 2, below, for a list of the Health Bucks evaluation team and key stakeholders. Health Bucks Evaluation Toolkit pg. 10

13 EXHIBIT 2: CORE HEALTH BUCKS EVALUATION TEAM AND KEY STAKEHOLDERS Health Bucks Evaluation Team Key Stakeholders CDC s Division of Nutrition, Physical Activity, and Obesity (DNPAO) NYC Department of Health and Mental Hygiene (NYC DOHMH) Abt Associates, Inc. Representatives from the Farmers Market Federation of New York Staff from each of the three NYC District of Public Health Offices (DPHOs) Program coordinators from local community-based organizations (CBOs) Farmers market operators, managers and vendors (ex: Greenmarket) Farmers market incentive program representatives and evaluators (ex: Boston Bounty Bucks and Prescriptions for Health) SNAP participants and other high-risk individuals targeted by the NYC Health Bucks program A summary of the questions addressed through the process evaluation is below. For a full list of process evaluation questions and data sources, see page 28. EXHIBIT 3: PROCESS EVALUATION QUESTIONS Process Evaluation Questions What are the differences across District Public Health Offices, changes over time, barriers and facilitators to Program funding? Program implementation? Ex: promotion/outreach; recruitment of markets and community based organizations; distribution methods and redemption; reimbursements to farmers Roles of stakeholder organizations (and adherence to intended roles)? Program monitoring and evaluation to track operations and inform program improvement? Outcome Evaluation The purpose of the outcome evaluation was to assess the effectiveness of the Health Bucks program in increasing fresh fruit and vegetable access, purchase, and consumption in targeted low-income populations. The outcome evaluation used both qualitative and quantitative methods to meet this objective. Data from the New York City Community Health Survey were analyzed to see if changes in fruit and vegetable consumption over time were different after Health Bucks started in neighborhoods where the program operated. Surveys and focus groups were also conducted with farmers market shoppers and people who lived in Health Bucks neighborhoods to find out their perspectives on how Health Bucks changed their eating and food shopping habits. Surveys and interviews of farmers, vendors, and market managers asked about how Health Bucks changed the way farmers and markets operated. A summary of the questions addressed through the outcome evaluation is below. For a full list of outcome evaluation questions and data sources, see page 29. Health Bucks Evaluation Toolkit pg. 11

14 EXHIBIT 4: OUTCOME EVALUATION QUESTIONS Outcome Evaluation Questions Community-Level Outcomes Does the Health Bucks program increase the numbers of farmers' markets and individual farmers' market vendors who Operate in DPHOs; Accept SNAP benefits via wireless EBT scanners? Distribute and accept Health Bucks? Offer a greater amount and/or variety of fresh fruits and vegetables? Individual-Level Outcomes Are there differences in perceived accessibility, purchases, and consumption of fresh fruits and vegetables by level of exposure to and participation in the Health Bucks program? Key Standards for Effective Evaluation All steps in the NYC Health Bucks evaluation were continually assessed to ensure adherence to CDC s four key standards for effective evaluation: utility, feasibility, propriety, and accuracy. Regular input and feedback from the CDC and key program stakeholders ensured utility of the evaluation by identifying the information needs of evaluation users. Stakeholder involvement coupled with extensive Abt program evaluation expertise also ensured the feasibility of the evaluation given existing resource constraints and logistical concerns. To ensure propriety, all study protocols (e.g., surveys, focus group guides) and evaluation materials (e.g., process and outcome evaluation plans) approved by the Abt Associates Institutional Review Board (IRB), which assures that projects follow ethical guidelines and standards. In addition, our study was approved by the U.S. Office of Management and Budget (OMB); OMB clearance is a requirement for all federally-funded evaluations involving extensive data collection. In designing your own evaluation, be sure to build time for all obtaining all required approvals into your study timeline. Accuracy was addressed throughout the evaluation, through careful evaluation design, tool development, and data analysis. Findings Evaluation findings can be found in the Health Bucks Evaluation Final Report, coming soon. Health Bucks Evaluation Toolkit pg. 12

15 Program Evaluation: Techniques and Tools This section includes a description of the types of techniques and tools you and your evaluation team might use for data collection, in addition to a selection of tools used in the Health Bucks Evaluation. The Health Bucks Evaluation tools were developed through an iterative process based on process and outcome evaluation questions. Individuals consulted during tool development included Health Bucks program administrators, other Health Bucks stakeholders, experts with experience evaluating similar programs, and survey experts. These tools may be adapted for evaluation of farmers market incentive programs of any scale. Respondent Groups Ideally, an evaluation will collect information from several key groups, since each respondent group offers a unique perspective on program implementation and outcomes. Collecting data from a variety of groups allows for a comprehensive program assessment that incorporates multiple viewpoints and experiences. The Health Bucks Evaluation team collected data from the following respondent groups: Farmers market shoppers Residents of Health Bucks neighborhoods Farmers Market Farmers and Vendors Farmers Market Managers Community Organizations Program Administrators The evaluation team also developed a market observation form to assess the physical environment of farmers markets. In addition to primary data sources, the evaluation team used secondary data from the New York City Community Health Survey to assess changes in the target population over time. The full list of evaluation questions indicates data sources or respondent groups used to answer each question. Health Bucks Evaluation Toolkit pg. 13

16 Data Collection Methods A variety of data collection strategies may be used to learn about a program s implementation and impact. Each method has benefits and challenges. For this reason, it is often helpful to include more than one method in an evaluation design. A list of data collection techniques used in the Health Bucks Evaluation follows; refer to each data collection method to read about its benefits and considerations and to learn about how it was used in the Health Bucks evaluation. See page 18 to view a list of all evaluation tools available for download. You may use or modify Health Bucks evaluation tools in your evaluation. In fact, it is often helpful to use questions that are similar to those used in other evaluations so you can compare your results to others findings. Health Bucks Evaluation Data Collection Techniques Key Informant Interviews Surveys Focus Groups Observations Key Informant Interviews Key Informant Interviews are structured discussions with individuals who are able to offer unique knowledge and insight about program operations and impact. Benefits of Key Informant Interviews Excellent exploratory tool for use during the formative phase of an evaluation; can help define what evaluation questions should be, how data collection tools should be designed to answer evaluation questions, and which respondent groups the evaluation should focus on. May also be used as an explanatory tool following other data collection efforts to clarify points of confusion or provide potential explanations for surprising or unexpected results. Minimal logistical effort required, making this a resource-efficient way to gather information. Considerations for Key Informant Interviews Opinions collected from key informant interviews will not necessarily represent the experiences and perspectives of all potential respondents. For this reason, be sure to specify the types of respondents that are being included in your evaluation, based on the topics/questions you are addressing, when you present your analysis plan and later findings. Health Bucks Evaluation Respondent Groups for Key Informant Interviews Health Bucks program administrators and other stakeholders Community organization staff Farmers market operators Farmers market vendor/farmers Health Bucks Evaluation Toolkit pg. 14

17 See Appendix A to view Key Informant Interview guides and informed consent documents used during the Health Bucks Evaluation. Surveys Surveys are questionnaires that are administered on paper, online, or as an interview by telephone or in person to groups associated with the program being evaluated. Sometimes surveys are also given to a group that was not served by the program for comparison purposes. In all cases, it is important to follow standard protocols and procedures before developing and administering your survey. Benefits of Surveys Provide opportunities to reach and solicit information from a large group of respondents; best way to gather responses that represent your target population. If done with a representative sample of sufficient size, can provide information about program effects on a population level. Considerations for Surveys Resource-intensive data collection and analysis effort required. Explains what but often does not explain why; surveys often do not provide information about why respondents answer in the ways they do. Informed consent for participation may be necessary. Other researchers or programs may have developed similar surveys; using items from existing tools can provide a valuable point of comparison for your own results. Health Bucks Evaluation Respondent Groups for Surveys Farmers market consumers Farmers market farmer/vendors Farmers market managers Community organizations Residents of District Public Health Office (DPHO) neighborhoods, the primary target population for the NYC Health Bucks program. See Appendix B to view Survey Protocols used during the Health Bucks Evaluation, including informed consent forms for participants and guides and tools for survey staff. Health Bucks Evaluation Toolkit pg. 15

18 Focus Groups Focus groups are semi-structured group discussions that follow a carefully planned format to identify and clarify attitudes and beliefs about an issue. Benefits of Focus Groups Generate information and ideas about an issue. Provide evaluators with an opportunity to collect more detailed information than is possible through a survey. Allow for development of ideas through an interactive group process to a greater extent than is often achieved during one-on-one interviews or surveys. Provides information/explanation of why respondents answer in the ways they do (strengthens findings from survey). Considerations for Focus Groups Not appropriate for problem-solving or decision-making. Planning and facilitation can be labor-intensive. Informed consent for participation may be necessary. May require that an incentive for participation be provided. Incentive amounts will vary depending on the topic (e.g., sensitive information) and target audience (e.g., general public, specialized professionals). Health Bucks Evaluation Respondent Groups for Focus Groups Farmers market consumers See Appendix C to view Focus Group guides, consent forms, and recruitment materials used for the Health Bucks Evaluation. Observations Observations of farmers markets or other participating organizations are a useful process evaluation tool, and can provide a richer understanding of program implementation across markets or neighborhoods. Benefits of Observations Provide a primary data source to assess various aspects of program implementation and outcomes. Possible to complete with minimal resources; if observation forms are short, each market observation could require only minutes. Health Bucks Evaluation Toolkit pg. 16

19 Considerations for Observations Provide only one-time snapshot of market environment. Health Bucks Evaluation Observation Settings Farmers Markets See Appendix D to view the Farmers Market Observation Form used during the Health Bucks Evaluation. Secondary Data Sources There may be secondary data sources that are already being collected by another organization or group that could help in evaluating the program. For example, a local survey conducted systematically by the state or local public health department may include questions about how many servings of fruits and vegetables people eat every day, or a local advocacy group may compile information about numbers and locations of farmers markets. Additionally, your program may already collect some form of administrative data on program operations as a part of standard procedures that could be further analyzed as part of an evaluation. Benefits of Using Secondary Data Sources Because data have already been collected by someone else, additional resources are not needed to collect the data. Data from large surveys may have a wider reach than can be achieved with your evaluation resources, including perhaps providing data from a period before your program began for comparison purposes. Large surveys often use sophisticated data collection methods and questions designed by experienced survey researchers. Secondary data sources can provide important comparison standards for the same questions included in the evaluation s data collection. Administrative data from the program being evaluated often provide the only available detailed information on how it has changed over time. Considerations for Using Secondary Data Sources When you do not collect the data yourself, there is no way to ensure that secondary sources will have the exact information you need to answer your own evaluation questions. Check data to assure quality is sufficient for the evaluation. Accessing and analyzing complicated datasets may require significant technical expertise. Unless a survey specifically asks about your program, you may not be able to tell which respondents are program participants. Health Bucks Evaluation Respondent Groups New York City residents surveyed as part of the Community Health Survey Click here to access the Community Health Survey website. Health Bucks Evaluation Toolkit pg. 17

22 Dissemination of Findings: How to Share Results Once the evaluation is completed, it is important to share the results and/or evaluation procedures with a variety of stakeholders. This process is called dissemination. The Centers for Disease Control and Prevention (CDC) defines this process called dissemination as the process of communicating evaluation procedures or lessons learned to relevant audiences in a timely, unbiased, and consistent manner," with the ultimate goal of achieving "full disclosure and impartial reporting." iv Why Disseminate? Disseminating evaluation results can help you to: 1) Ensure audiences understand the issues addressed by the program 2) Increase understanding and awareness about the types of support needed for successful implementation 3) Inform program improvements 4) Help to secure additional or ongoing funding 5) Create positive publicity 6) Influence and encourage changes in policies and/or practices, both within program and elsewhere. 2 How and What to Disseminate The products developed for dissemination will vary depending on a variety of factors. The following are key questions to keep in mind when planning dissemination efforts: EXHIBIT 5: KEY QUESTIONS FOR DISSEMINATION Key Questions for Dissemination Who is/are the intended audience(s)? What does the audience need to know, and what are their specific interests? What does the evaluation team hope to gain by disseminating this information or these results? How will the evaluation team communicate about the program, while ongoing and upon its completion? 2 Once these questions have been answered, the types of products (e.g., articles, oral presentations, blogs, briefs, etc.) and mechanisms (e.g., conferences, mass media, journals, websites, etc.) can be determined. Potential audiences, products and mechanisms are listed below. Health Bucks Evaluation Toolkit pg. 20

23 Target Audience Funders/donors Program stakeholders & staff (e.g., state and local health department staff and administration/ farmers market representatives) Organizations implementing similar programs Participants in program General public Policymakers Academic Institutions Dissemination Products Formal evaluation reports Press release or issue briefs Promotional products such as brochures, posters, billboards, flyers, or videos Presentation (slide or poster) Peer-reviewed article Data collection tools Success stories/lessons Learned Dissemination Mechanisms Website Conference Local or national media sources Journal or other publication Special event or meeting Targeted location (e.g., Farmers Market, cooking demonstration table/booth) Consider Your Audience It is important to match the style, tone, education level, timing, format, and mechanism of each dissemination effort to the needs of the target audience. 1 For example: To reach the public, oral presentations, videos, and displays may be more memorable, effective, and therefore preferred. Slide presentations, news releases or press conferences, radio and television coverage, and public meetings help to educate and encourage discussion among attendees. Health Bucks Evaluation Toolkit pg. 21

24 To reach stakeholders or program staff, listservs and web-based resources may prove the most beneficial. Display of promotional materials at farmers markets and in-person meetings are important for reaching program staff and key stakeholders. 2 To reach conference/workshop participants, policymakers, and funders/donors, consider use of print formats such as brochures, one-page descriptions, newsletters, executive summaries, or technical reports. The following example, adapted from CDC s Framework, may help guide plans for reaching the various target audiences. v EXHIBIT 6: SAMPLE DISSEMINATION APPROACH AND RECOMMENDATIONS vi Sample Dissemination Approach Audience: State and local health department staff/health department administration. Purpose of evaluation: Demonstrate impact of program on target populations knowledge and consumption of fresh fruits and vegetables. Evaluation findings: Farmers market incentive coupons were distributed to low-income residents of three targeted neighborhoods. In a survey of neighborhood residents, xx% or respondents were familiar with the incentive program and xx% had used the incentive coupons. Recommendation: We recommend increasing funding in order to expand the program to reach new neighborhoods and farmers markets. When to Disseminate Dissemination of information can and should occur throughout all phases of program implementation to improve quality and assess progress at each state of the logical model. Special opportunities for dissemination may present at the time of special events or critical junctures for your organization such as a new achievement, recognition or an award, or as part of a fundraising campaign. Alternatively, dissemination efforts may be timed to coincide with events that relate to the issues addressed by program, i.e., start or end of the annual farmers' market season. vii Findings of the overall evaluation should be disseminated at the end of the evaluation. Checklist for Effective Dissemination viii The following checklist developed by CDC may prove useful as you plan your dissemination and develop dissemination products. Health Bucks Evaluation Toolkit pg. 22

25 Health Bucks Evaluation Toolkit pg. 23

26 Dissemination Materials The following list provides examples of oral, poster, promotional and paper products developed to disseminate the approach to and results of Abt Associates' evaluation of New York City Health Bucks program. Poster Presentations: Formative Activities in Support of an Evaluation of the New York City Health Bucks Program. Poster presentation at the Annual Meeting of the American Dietetic Association, Boston, MA, November 2010 and at the American Public Health Association Annual Meeting, Denver, Colorado, November Papers and Panel Presentations: Evaluation of a Farmers' Market Incentive Program: The New York City Health Bucks Initiative. Panel presentation at the American Public Health Association Annual Meeting, Washington, DC. November Evaluation of the New York City Health Bucks Farmer s Market Incentive Program: Demonstrating the Value of Stakeholder Input for Evaluation Design, Implementation and Dissemination. Panel presentation at the American Evaluation Association Annual Conference. November, Healthy Food Incentives: Their Impact Now and in the Future Workshop; Evaluating Farmers Market Incentive Programs: the Example of Health Bucks. Panel Presentation at the Community Food Security Coalition Food Justice Conference, Oakland, CA. November, Enhancing the Quality of Evaluation through Collaboration among Funders, Programs, and Evaluators. Panel presentation at the Evaluation 2010 Conference of the American Evaluation Association, San Antonio, TX, November Other Dissemination Products: The New York City Department of Mental Health and Hygiene has created press releases to share information about the Health Bucks program. See Appendix E to see the press release from CDC has developed a one-page information sheet to discuss the evaluation and its results (see Appendix E). More information sheets to come in the near future. Health Bucks Evaluation Toolkit pg. 24

27 References i Centers for Disease Control and Prevention. Framework for program evaluation in public health. MMWR 1999;48 (No. RR-11):1-40 ii Ibid. iii Ibid. iv Centers for Disease Control and Prevention. Office of the Director, Office of Strategy and Innovation, & National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases. Introduction to program evaluation for public health programs: Evaluating appropriate antibiotic use programs. Atlanta, GA: Centers for Disease Control and Prevention, v Centers for Disease Control and Prevention. Office of the Director, Office of Strategy and Innovation, & National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases. Introduction to program evaluation for public health programs: Evaluating appropriate antibiotic use programs. Atlanta, GA: Centers for Disease Control and Prevention, vi Centers for Disease Control and Prevention. Office of the Director, Office of Strategy and Innovation, & National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases. Introduction to program evaluation for public health programs: Evaluating appropriate antibiotic use programs. Atlanta, GA: Centers for Disease Control and Prevention, vii Centers for Disease Control and Prevention. Disseminating Program Achievements and Evaluation Findings to Garner Support. Evaluation Briefs. Feb Web. <http://www.cdc.gov/healthyyouth/evaluation/pdf/brief9.pdf>. viii Centers for Disease Control and Prevention. Office of the Director, Office of Strategy and Innovation, & National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases. Introduction to program evaluation for public health programs: Evaluating appropriate antibiotic use programs. Atlanta, GA: Centers for Disease Control and Prevention, Health Bucks Evaluation Toolkit pg. 25

28 Web Addresses Page 1 New York City Health Bucks program, Center of Excellence for Training and Research Translation website at Page 5 CDC s Healthier Workplace Initiative Logic Model page at Page 10 Health Bucks program at CDC Framework for Program Evaluation for Public Health at Page 13 New York City Community Health Survey at Page 17 Community Health Survey website at Page 24 Centers for Disease Control and Prevention. Office of the Director, Office of Strategy and Innovation, & National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases. Introduction to program evaluation for public health programs: Evaluating appropriate antibiotic use programs. Atlanta, GA: Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. Disseminating Program Achievements and Evaluation Findings to Garner Support. Evaluation Briefs. Feb Web at Checklist for Effective Dissemination at Health Bucks Evaluation Toolkit pg. 26

29 Health Bucks Evaluation Toolkit pg. 27

30 Administrative Data Document Review Key Informant Interviews Local Community Organizations Surveys Market Manager Surveys Vendor Focus Groups Vendor Surveys Consumer Focus Groups Consumer Surveys Health Bucks Evaluation Process Evaluation Questions Potential Data Sources Is program funding sufficient to achieve intended goals? Is funding sustainable in the longer term? Can alternative funding sources be identified? x x x Does program implementation differ across the three individual DPHOs? x x x Do key individuals and organizations adhere to intended roles in implementing the program? What are barriers and facilitators to coordination across these groups? Are existing promotional and outreach efforts sufficient for reaching targeted Health Bucks participants? How can these efforts be improved? What are barriers and facilitators to recruitment of farmers market and local community organizations to participate in the NYC Health Bucks program? How are Health Bucks allocated across these groups? What is the optimal timing for allocating Health Bucks to farmers markets and community organizations? What are the benefits and drawbacks to alternative Health Bucks distribution methods? Are Health Bucks distributed by each method actually reaching their intended recipients? x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Do local community organizations tie Health Bucks distribution to participation in nutrition education or other wellness activities? How does this influence the number and type of recipients? More generally, how do local community organizations determine to whom to distribute Health Bucks, and how many Health Bucks to distribute to each individual? x x x What factors influence redemption of Health Bucks by recipients? x x x Are all Health Bucks redeemed as intended, for the purchase of locallygrown, fresh fruits and vegetables at farmers markets, or are some redeemed for other products or in alternative venues? Are farmers reimbursed for Health Bucks purchases in a timely and efficient fashion? What are barriers and facilitators to this process? Are existing oversight, monitoring, and evaluation processes adequate to inform program administration and key stakeholders? x x x x x x x x x x x x x Health Bucks Evaluation Toolkit pg. 28

33 Formative Key Informant Interview: NYC Health Bucks Coordinator Name of Respondent: Title: Date of Interview: Location of Interview: Name of Interviewer: List questions emerging from review of instruments + questions that will emerge during site visit: 1. What is the correct wording for the Health Bucks (HB) program? 2. Do you know what proportion of Health Bucks recipients receive Supplemental Nutrition Assistance Program (SNAP) or Women, Infants, and Children (WIC) benefits? 3. What is the association between Farmers Market Federation (FMF) and Greenmarket (GM) is GM part of FMF? 4. Please describe how community orgs are selected for participation in HB. a. What is involved in the application process? b. Are there requirements for participation (e.g., tracking distribution and/or redemption of HBs, etc.)? 5. What is your role/involvement in other NYC food access initiatives (e.g., Healthy Bodegas, NYC Green Carts, FRESH Program)? a. Are these initiatives and HB linked to broader policy efforts? b. How are these initiatives coordinated? 6. Can we get addresses for community organization and Farmers Market (FM) managers in order to administer web surveys? 7. To your knowledge, do any FMs have access guidelines to the FMs (e.g., allow dogs, stollers, etc.)? 8. Do you know how most customers access the FMs? a. How do they get to the FM? b. How to they depart from the FM? c. Is there someone else we could ask for this information? 9. Do you have an organizational chart or implementation map for HBs and related programs? NYC Health Bucks Coordinator Formative Key Informant Interview - 2 -

35 Formative Key Informant Interview: DPHO Representative Name of Respondent: Title: Date of Interview: Location of Interview: Name of Interviewer: Intro from us about why we are conducting interviews (to learn about the markets and how they operate and to understand factors that would facilitate our evaluation). Tell us about your district and the neighborhoods and populations in the district. 1. How large is the district? 2. How many distinct neighborhoods are in the district? 3. Describe access to general nutrition and education about healthy behaviors (e.g., exercise). a. What are the barriers to access? 4. More specifically, describe the access to fresh fruits and vegetables. a. What are the barriers? We d like to ask a few questions more specifically about the FM s operating in your district: 5. How many FMs are there? a. Has the number changed over time? 6. How would you characterize the FMs (size geographic, # of vendors; busiest time of the season; target populations; accessibility, how long have they operated; how they have evolved or changed over time; are all Electronic Benefits Transfer (EBT); how many offer nutrition education)? 7. What is your role in administering/overseeing the FMs? 8. What kinds of vouchers/coupons are accepted at the FMs in your district? b. Does this differ by FM? 9. What is your role or involvement with HB? c. Who do you work most closely with to run/oversee the program? 10. Are there differences between the FMs in your district that accept HB and those that do not? DPHO Formative Key Informant Interview - 2 -

36 11. How many FMs participate in HB? d. Has this changed over time? 12. Are there differences among the FMs that accept HB? e. Has this changed over time, and if so, in what ways? 13. How did the relationship with HB come about? 14. How is the HB program administered in your district? f. Has this changed over time? 15. In general (not specific to HB), what is your process, and the criteria, for selecting vendors for the FM (e.g., application process, part of an association, other)? g. When does selection take place (e.g., are vendors scheduled at the beginning of the season, month, week, etc.)? 16. In general, what level of data do you collect about the vendors and booths and the produce they sell, esp., fresh fruits and vegetables? 17. What determines if a vendor participates in HB? h. Has this changed over time? 18. How do you track distribution and redemption of HBs? i. Has this changed over time? j. Have you compiled these data and and made any changes in the HB program or market operations as a result? 19. Are there barriers to distributing the HBs to k. Consumers (via Community Based Organizations or EBT or Market Managers)? l. Can these be overcome? 20. Are there barriers to redeeming HBs for m. Consumers? n. Vendors? o. Can these be overcome? 21. What are the benefits of having the HB program in your district? p. Any drawbacks? 22. Do you collect data about the HB program and its potential impact (e.g., vendor and/or consumer satisfaction, consumption)? How often? DPHO Formative Key Informant Interview - 3 -

37 q. Have you made any changes as a result? 23. Do you think the HB program has made a difference r. In increasing consumption of fresh fruits and vegetables? If so, how? s. In expanding access to locally grown produce at FM s in low-income neighborhoods? 24. Are there any lessons learned or important considerations for our evaluation that you can share with us about: t. The characteristics of your markets (environmental, structural, etc.) u. The characteristics of the FM clientele v. How to identify and approach HB users? w. How to approach vendors? 25. Are there any advertising or marketing materials that would be helpful to have (e.g., brochures, flyers, mailings, etc.)? We have just a few questions about how you partner with other agencies. 26. How do you coordinate with the Department of Health and Mental Hygiene (DOHMH) to administer HB? 27. For what purposes? 28. How often? 29. How do you coordinate with community organizations about HB? 30. How do you coordinate with the Farmer s Market Federation to administer HB? 31. For what purposes? 32. How often? 33. What are the challenges associated with administering the program? 34. What are the challenges associated with sustaining the program (e.g., financial, etc.)? 35. What parts of the HB program are most adaptable to other settings (e.g., bar codes, etc.)? 36. Are there other programs operating in your district with the purpose of increasing access to fresh fruits and vegetables and/or providing education about nutrition and physical activity? DPHO Formative Key Informant Interview - 4 -

38 37. What agencies to you partner with for these programs? 38. Do these programs or agencies coordinate with HB in any way? 39. As a closing question, what do you think it will take to improve education about nutrition/healthy eating and specifically to break down access barriers to fresh fruits and vegetables? (If not answered already). 40. Is there anything we haven t asked that might be important for us to know? DPHO Formative Key Informant Interview - 5 -

40 Formative Key Informant Interview: Farmers Market Federation Name of Respondent: Title: Date of Interview: Location of Interview: Name of Interviewer: HISTORY AND ROLE OF FEDERATION (NOT RELATED TO HB) 1. Can you tell us a little about the history of the Farmers Market Federation? 2. What is the mission/purpose of the organization? 3. How does the Federation carry out that mission? 4. How large is the organization? a. Has it grown in staff, in catchment area, other? 5. Is the Federation a membership organization? a. Do markets or individual vendors become members? b. How does a FM become a member? c. Are there dues or fees? Annual or other? d. What benefits or services does a member receive? 6. How many members do you currently have? a. Has this changed over time? b. How many NYC FMs are not members/part of the Federation? 7. Is the Federation involved in the process for certifying farmers or FMs (with the NY State Dept. of Agriculture and Markets)? a. Is the Federation involved in any other ways with the Dept. of Agriculture and Markets? 8. Does the Federation interact with the FM managers? a. If so, in what capacity? b. What is the Federation s role in administering the EBT programs? c. Do FMs share EBT with one another or do proprietors who run more than one FM use the same EBT machine at more than one market? d. Do consumers have to use the EBT tokens the same day they acquire them? i. If not, do they have to be used within a certain timeframe? 9. Does the Federation interact directly with any vendors/farmers? a. If so, in what capacity? b. How do farmers get reimbursed for payments made with EBT/food stamp tokens? i. How does the reimbursement/payment process work (mail in tokens, when, to whom)? ii. When do farmers get paid; by whom? 10. Does the Federation get involved in deciding which vendors/farmers sell at which FMs? a. If so, in what capacity? 11. Do vendors commit to a FM for an entire season or can the commitment be shorter (e.g., monthly/weekly)? 12. Does the Federation s interact with the DPHOs? a. If so, in what capacity? 13. Does the Federation s interact directly with Community Based Organizations (CBOs)? a. If so, in what capacity?

41 FEDERATION S INVOLVEMENT WITH HEALTH BUCKS 14. How did the Federation become involved with Health Bucks? When? 15. What is the Federation s role in the Health Bucks program? a. Has this role changed over time? 16. Is the Federation involved in the planning process for the HB program each year (e.g., how many HBs to print; how to distribute them and to whom, etc.)? 17. Is the Federation involved with the CBO application process for HBs (e.g., reviewing or approving applications)? 18. Is the Federation involved with marketing the HBs program in any way? 19. Is the Federation involved with distributing HBs (either to CBOs or to FMs)? 20. Is the Federation involved in the redemption of HBs: b. Tracking (for both CBOs and FMs; are there forms; how does this work)? i. What do you track? Who gets the data (e.g., Department of Health, DPHOs, FM managers, CBOs, individual farmers/vendors)? c. Payment/reimbursement to farmers for HB (what is the process; when do farmers get paid?) 21. Has the Federation conducted any kind of evaluation of HB (e.g., satisfaction surveys, other)? d. Which groups have you surveyed (e.g., consumers, farmers/vendors, managers, etc.)? e. How often have you surveyed each group? f. What have you learned from these activities? g. How has the Federation or the HB program changed in response to these findings? 22. Any lessons learned for us as we prepare for our evaluation and data collection? IF WE DON T ALREADY KNOW, ASK ANY OF THE FOLLOWING: 23. Does the Federation interact directly with any vendors for the HB program? a. If so, in what capacity? 24. Does the Federation get involved in which FMs accept HB? b. If so, in what capacity? 25. Does the Federation get involved in which vendors at the FMs accept HB? c. If so, in what capacity? 26. Does the Federation s interact with the DPHOs for the HB program? d. If so, in what capacity? 27. Does the Federation s interact directly with CBOs for the HB program? e. If so, in what capacity?

43 Formative Key Informant Interview: Greenmarket Representative Name of Respondent: Title: Date of Interview: Location of Interview: Name of Interviewer: Ask any additional questions from master DPHO list, as appropriate, plus: 1. Briefly describe the history of Greenmarkets? 2. How are Greenmarkets different from other FMs around the city? 3. How are Greenmarkets different a. from one another? b. Across boroughs? 4. How did Greenmarkets become involved with the HB program? a. When did this involvement begin? b. Has it changed over time? 5. Do all Greenmarkets participate in the HB program? a. If not, what determines if a Greenmarket participates? 6. What is the process for participating in HB? a. What is your association with DOHMH? b. What is your association with FMF? 7. How are HBs distributed at your market? 8. How are HBs redeemed at your markets? 9. Do you advertise the HB program? 10. What is Greenmarket s involvement with implementing, monitoring, and/or tracking HBs? a. Are you involved in this role? b. Are FM managers involved in this role? 11. Do individual FM Managers manage more than one FM? a. If so, any suggestions for how to minimize burden of responding to survey for each specific market? Greenmarket Formative Key Informant Interview - 2 -

44 12. What level of data do you collect about the vendors and booths and the produce they sell, esp., fresh fruits and vegetables? 13. Do your markets offer nutritional or wellness programs/education? a. Please describe. b. Have you implemented or expanded any programming as a result of HB? c. Are HBs offered as an incentive for customers to participate in these programs? 14. Any suggestions for improving any component of the HB program or how you coordinate or are involved with the program? Greenmarket Formative Key Informant Interview - 3 -

46 Formative Key Informant Interview: Stellar Market Representative Name of Respondent: Title: Date of Interview: Location of Interview: Name of Interviewer: Role 1. What is your role or involvement with Health Bucks? 2. More broadly, what is your role within the health department? What else are you responsible for? 3. What, if anything else, is linked to Health Bucks? Program description 4. What are the Stellar Markets? 1 (get background on when they began, who is involved with them, where are they located and why were they initiated) 5. Which of the 8 markets are Stellar Markets? 6. Do you have plans to expand to more markets? 7. Do you know which markets will be Stellar markets in ? 8. Are the Stellar Markets different at Health Bucks sites? 9. To what extent are farmers' market managers involved in the nutrition education component? 10. To what extent are vendors/farmers involved in the nutrition education component? 11. How are the nutrition education classes advertised at the markets and prior to the markets? 12. How do you decide which markets should have the education component? Who makes this decision? 13. How do you advertise the educational activities that are offered? 14. Are there other ways through which customers become aware of these activities (posted list; mailed list, etc.)? a. Is there a name or specific terminology by which customers might refer to these activities? 15. Do you have a curriculum that you follow at each market? (To see if it's standardized, or varied by "clientele") 16. What do we need to know about the people who attend the educational classes and workshops? 17. Knowing what we'll be doing, are there any considerations or need-to-know information about HB and the nutritional program? Is there anything else we need to know about the Stellar Markets or HB that would help us with our site visit? 1 The Stellar Farmers Market Initiative, a program of the NYC Department of Physical Activity and Nutrition Program, aims to promote the benefits of a diet rich in fruits and vegetables and encourage New Yorkers to make use of local, fresh produce when preparing meals. Stellar Farmers Markets offer nutrition education in the form of cooking demonstrations, and utilize the Just Say Yes to Fruits and Vegetables curriculum, providing cooking demonstrations in both English and Spanish. Stellar Farmers Markets operate in close cooperation with the Health Bucks program, commonly offering Health Bucks to consumers as part of on-site cooking demonstrations as an incentive and promotional activity. Stellar Market Formative Key Informant Interview - 2 -

48 Formative Key Informant Interview: Community Organization Representative Name of Respondent: Title: Date of Interview: Location of Interview: Name of Interviewer: I. Health Bucks Application and Transfer to Organizations 1. Health Bucks Application a. When did you become involved with Health Bucks? b. How did you first hear about Health Bucks? c. Why did you want to distribute Health Bucks? d. What does the application process entail? e. Suggestions for improvement of application process 2. Health Bucks Transfer to Organizations a. When did you receive Health Bucks? i. Who/what organization provided you with the HB? (e.g., DPHO, other)? b. Were Health Bucks received at a good time? c. Did you receive enough Health Bucks? d. Suggestions for improving transfer of Health Bucks to organizations? II. Health Bucks Eligibility, Distribution, and Administration 1. How do you advertise Health Bucks to clients? 2. What demographic groups are Health Bucks distributed to? 3. What other criteria is used to determine eligibility for Health Bucks? 4. Was Health Bucks distribution tied to participation in events, classes or workshops? What type of events (e.g., nutrition or wellness education)? a. Were Health Bucks provided as an incentive, or just given out? b. Did you implement or expand such efforts as a result of HB? 5. When did you distribute Health Bucks to clients in the month/season? 6. Which staff (how many staff members?) distribute Health Bucks? 7. Did you distribute all of the Health Bucks you received? Community Organization Formative Key Informant Interview - 2 -

49 a. If not, how many did you distribute? Why not (list)? 8. How many Health Bucks distributed to each recipient at a time? 9. If Health Bucks are distributed to the same recipient more than once, how often are recipients given Health Bucks? 10. What is the maximum number of Health Bucks each person may receive? 11. How did you track distribution of Health Bucks? a. Do you do this yourself or does another organization do the tracking? b. Are there specific forms that you use? 12. How did you track redemption of Health Bucks? a. Do you do this yourself or does another organization do the tracking? b. Are there specific forms that you use? 13. Have you used the information you track to change the HB program or any other processes or programs provided by your organization? 14. Suggestions for improving the distribution of Health Bucks and the administration of the Health Bucks program next year? III. Nutrition and Health Programming for Health Bucks Recipients (Note: I incorporated a few of questions into those above) Community Organization Formative Key Informant Interview - 3 -

50 Health Bucks Evaluation Farmer/Vendor Interview Consent Script

51 INFORMED CONSENT FORM FARMER INTERVIEW Health Bucks Evaluation Telephone Interview Consent Script The purpose of this interview is to learn about New York City Farmers experiences with the Health Bucks program. Health Bucks are $2 coupons that can be used to buy fresh fruits and vegetables in some New York City farmers markets. The Farmers Market Federation of New York (FMFNY) runs this program for the NYC Department of Health. Abt Associates Inc., a research firm, is studying the Health Bucks program for the Centers for Disease Control and Prevention (CDC). We will use what you and other farmers say to learn about the effect of this program on New York City farmers markets. Interviews will also help us understand how to make the program better. The interview will take about 1 hour. Taking part in this interview has minimal risks for you. The main risk is that your responses could be disclosed in a way that identifies you. However, many procedures are in place to lower this risk. There are no costs for completing the interview. The information you share today will be maintained in a secure manner. Protections will be in place to protect your response to the maximum extent allowed by law. We will not link your name, address, or phone number to anything you say today, and will not use your name in any of our reports. We will take notes during our discussion, but will only report what you say combined with what other farmers say. What you say will not be shared with the CDC, the Department of Health, or the Farmers Market Federation of New York. Your participation in the interview is voluntary. Even if you do participate, you do not have to answer all of the questions. Your choice will not change your relationship with CDC, the NYC Department of Health, or the FMFNY. Following the interview, we will send you a Postal Money Order in the amount of $35 to thank you for your time. If you have any questions, you may call Lauren Olsho of Abt Associates Inc. at You may also call Teresa Doksum, at if you have other questions about your rights as part of this study. Calling these numbers will incur a toll. Given the information I read above, is it ok to move forward with the interview? Participant Name Interviewer Signature (Please print) Date

52 Health Bucks Evaluation Farmer/Vendor Interview Guide 1

53 I. Background: Organization and Process To start, we have some general questions about your farm and selling at farmers markets: 1. Where is your farm(s) located? town(s)/city(ies) and state(s)? 2. What do you grow/produce at your farm (i.e., key crops/produce, we don t need an inventory)? 3. In general, how do you decide where to sell your produce? (probes: target pop (define), size of sales market, sales volume, price/variety of products, other) 4. What led you to begin selling at farmers markets? When did you begin selling at FMs? Where are the markets located at which you sell (within NY State, outside of NY State)? Why do you continue to sell at FMs? 5. We understand that you sell your produce at farmers markets in NYC. At which NYC markets do you sell your products? How long have you been selling produce at NYC farmers markets? How did you decide to sell at these specific markets (probe: if more than one market, are the markets different in characteristics (e.g., size/# of booths, product variety, sales volume, neighborhood/environment)?) Do you always seek out the markets at which to sell or do the markets ever contact/recruit you? 6. To help us understand the logistics of selling at farmers markets, could you briefly describe: How produce gets transported to the markets What determines how often the produce gets transported from your farm (e.g., if a market is open only one day a week vs. multiple days a week). What happens to the produce at FMs that are open on multiple days of the week. Who sells your produce at the markets (i.e., who staffs the booth). Should we need more information about front-line interaction with FM customers, could we contact someone who staffs one of your booths? At the end of the interview we can discuss your preferences for how we make the contact. 7. Overall, what trends or new directions have you noticed in farms and farmers markets? II. Farmers Market Application Process The next set of questions is about what you have to do to be able to sell at farmers markets. 8. Please describe any licenses, certifications or other requirements that you must meet to sell at farmers markets in NYC (in general, not specific markets? From what organization(s)? What does being certified or licensed mean? 9. Did you pay any fees for this certification/license? If yes, is this/are these one-time fee(s) or repeat (e.g., every year, etc.)? Have the fees changed over time (e.g., increase/decrease)? 10. Do specific markets have any requirements or standards that you must meet? (e.g., application process, farm must be local to area, scale of operation, organic, etc.)? 2

54 Do any of these requirements vary by farmers market (e.g., an independent market vs. Greenmarket, Harvest Home, other)? Are there fees to pay to the FM associated with this process? o What are the fees for? 11. Are you a member of any farmers market association or federation? Is this a requirement to sell at FMs in NYC? Do you pay any fees as part of the process? Annually? What are the benefits and drawbacks of membership? 12. Would you change anything about the processes/procedures required to sell at the farmers market(s)? III. Sales and Payment Methods 13. How do you decide what produce to sell at the farmers market? If you sell at more than one farmers market, do the products you sell vary by market? If so, in what ways? Have the products you sell changed over time? For what reasons. 14. How do you decide how much of a product to bring on each market day? Are some products more popular than others? 15. How do you decide what prices to charge for your products? How often do prices change (e.g., daily, weekly, monthly, etc.)? Do prices vary across different farmers markets? o If so, what influences price (e.g., market characteristics, crop yields, cost of selling at the markets, etc.)? 16. Which methods of payment are most commonly used by your customers? (Probe: cash, debit/credit card, food stamps (SNAP), WIC or Senior Farmers Market Nutrition Program (FMNP) coupons, WIC vouchers, Health Bucks, other)? (Farmer & Vendor) Has this changed over time? Since when? In what ways? Does this vary by market or neighborhood? Describe. 17. Do you prefer any forms of payment (which ones)? What makes these payment methods preferable? Are there drawbacks to any of the other payment methods you accept? 18. Are there any forms of payment that you prefer not to accept? If so, for what reasons? 19. Do you have any suggestions for changing the payment methods at farmers markets? 20. Thinking about what you have shared about your experiences selling at farmers markets, What are some of the benefits of selling your products at farmers markets? What are some of the drawbacks or challenges of selling your products at farmers markets? 3

55 IV. Experience with Health Bucks 21. Do you know about the Health Bucks Program? (F&V) If so, how did you learn or hear about the Health Bucks Program? If you do not know about Health Bucks, would you be interested in learning more about the program? (Note: If so, we can send you some information at the end of our discussion.) 22. Do you accept Health Bucks as a form of payment? At all farmers markets where you sell your products? If no, why not? o Is there anything that would influence your willingness to try or use Health Bucks? 23. How did you decide whether or not to participate in the Health Bucks program? 24. Do you advertise/display that you accept Health Bucks? (F & V) 25. Has there been a time when you haven t accepted a Health Buck? (F&V) If so, for what reason(s)? 26. How does the process of paying with a Health Buck work? (Vendor only) Is the process convenient for you? Based on your observations, is the process convenient for the consumer? Why or why not? Is there a time when consumers use the Health Bucks more or less during a day, week, month, or season? o If so, do you know what might influence when HBs are used? 27. Can customers use an additional form of payment along with a Health Buck? (Vendor only) If so, what different forms of payment are most often used together, in your experience? Does this complicate the transaction process for you? Explain. 28. Once you have received the Health Buck as payment from a customer, what do you do to receive your payment/reimbursement? How often do you send in/redeem the Health Bucks for payment? o To what organization? How/in what form do you receive the payments (check, direct deposit, etc.)? 29. Would you change anything about the payment or redemption process? Is this process different from that of other vouchers or coupons? 30. When do you receive your payments for the Health Bucks? Would you change anything about the timing? Is the timing for receiving payments different from that of other vouchers or coupons? 31. Has the Health Bucks program had an influence on the volume or variety of products you sell? (F&V) If so, in what ways? 32. Have you seen a change in the volume of Health Bucks used by customers at your booth(s)? (F&V) (Probe: Do customers receive their Health Bucks at opportune times in the season?) Accepted by other farmers/vendors? Explain. 4

57 Key Informant Interview NYC DOHMH Staff Toolkit & Dissemination Questions 1) What do you wish you had known when you first began considering an evaluation of the Health Bucks program? Did you have access to any evaluation toolkits or other helpful information during this time? If so, may we use/provide links to them in our toolkit? 2) Are there any notable lessons learned about evaluating the Health Bucks program? What went well and what could have been done differently? 3) What influence did the Centers for Disease Control and Prevention s (CDC) evaluation of the program have on a) your program and b) your own internal evaluation? 4) What are the ways in which you have disseminated/plan to disseminate your evaluation findings (e.g., reports, brochures, tool kits, etc.)? If you have examples to share with us, may we use/provide links to them in our toolkit? Do you have any advice about particularly effective ways to disseminate evaluation findings? 5) Based on your experience with evaluation, what do you consider to be important for designing an online toolkit for evaluation? What is essential to include/not forget? What should we avoid doing/including? Any general guidelines? Questions for the evaluation report 6) Roles of key individuals and organizations in implementing the program Do key individuals and organizations adhere to intended roles in implementing the program? What are barriers and facilitators to coordination across these groups? 2

58 7) Barriers and facilitators to recruitment of farmers market and local community organizations to participate in the program What are barriers and facilitators to recruitment of farmers market and local community organizations to participate in the NYC Health Bucks program? How are Health Bucks allocated across farmers markets? Talk to us about your efforts with the U.S. Department of Agriculture (USDA) to get EBT into FMs. Was this related to addressing barriers or facilitators? 8) Program funding and sustainability questions ** Think about these questions more generally based on your experience. What have been the funding sources for all aspects of the Health Bucks program? i. Has that changed over time? To date, has program funding been sufficient to achieve intended goals? Are you still working toward the original Health Bucks goals? Thinking about longer term funding, how is the program going to be sustained? Have you identified alternative funding sources for the Health Bucks program? Describe. Do you think about sustainability in other ways besides funding? 9) Oversight, monitoring, and evaluation processes Are existing oversight, monitoring, and evaluation processes adequate to inform program administration and key stakeholders? What else would you do for oversight and monitoring? What are the next steps for your own program evaluation? What will you do next year? 3

59 33. Based on your observation, has the Health Buck program had an influence on your customers? (Vendor only) If so, in what ways? 34. Have you seen a change in the types of people using Health Bucks? If so, in what ways? (Vendor only) 35. Thinking more specifically about your experience with the Health Bucks program, What are some of the benefits of accepting Health Bucks for your products at farmers markets? What are some of the drawbacks or challenges of accepting Health Bucks your products? 36. Would you like to see the Health Bucks program (F&V) Continue Grow Change in any way? Are there any questions you have for us? Anything else you d like to share about talking to farmers about Health Bucks and farmers markets? 5

61 ABOUT THIS STUDY This is a survey of New York City farmers market shoppers. We want to learn your thoughts about farmers markets. We also want to learn what you think about the New York City Health Bucks program. This program gives out $2 coupons called Health Bucks. Shoppers can use Health Bucks to buy fresh fruits and vegetables in some New York City farmers markets. The Farmers Market Federation of New York runs this program for the NYC Department of Health. Abt Associates, Inc., a research firm, is studying the Health Bucks program for the Centers for Disease Control and Prevention (CDC). We will use your answers to learn how this program affects New York City farmers markets. We will also learn how to make the program better. The survey should take about 7 minutes. RISKS OF TAKING PART IN THE STUDY Being in this survey has minimal risks for you. COSTS AND FINANCIAL RISKS There are no costs for being in the survey. POSSIBLE BENEFITS OF TAKING PART IN THE STUDY Being in this survey will help improve farmers markets and the Health Bucks program. This could bring more cheap, healthy foods to your area. COMPENSATION You will get a round trip MetroCard (worth $4.50) for being in the survey. DATA SECURITY Information collected as part of this survey will be maintained in a secure manner. Protections will be in place to safeguard your response to the maximum extent allowed by law. We will not ask your name, address, or phone number. We will keep forms in a secure, locked room at Abt Associates. We will enter your answers into a computer file. We will store the file with a password on a secure server at Abt Associates. We will only report your answers combined with answers from 2,000 other surveys. We will destroy all surveys at the end of the study. TAKING PART IS VOLUNTARY You can choose not to fill out the survey. If you do not fill out the survey, there will be no penalty. Even if you agree to fill out the survey, you do not have to answer all the questions. Your choice will not change your relationship with the CDC, the NYC Department of Health, or the Farmers Market Federation of New York. QUESTIONS You may call Lauren Olsho of Abt Associates Inc. ( ) to learn more. You may also call Teresa Doksum, IRB Administrator ( ), if you have other questions about your rights as part of this study. Calling these numbers will incur a toll. TELL US WHAT YOU THINK As part of this study, we invite you to join us for a focus group (small group discussion) about your experiences with shopping at farmers markets. Anything you share with us will be kept private. If you are able to join us, you will receive $35. If you would like to learn more about coming to the group discussion, please call this number:

64 ABOUT THIS STUDY This is a survey of New York City farmers market shoppers. We want to learn your thoughts about farmers markets. We also want to learn what you think about the New York City Health Bucks program. This program gives out $2 coupons called Health Bucks. Shoppers can use Health Bucks to buy fresh fruits and vegetables in some New York City farmers markets. The Farmers Market Federation of New York runs this program for the NYC Department of Health. Abt Associates, Inc., a research firm, is studying the Health Bucks program for the Centers for Disease Control and Prevention (CDC). We will use your answers to learn how this program affects New York City farmers markets. We will also learn how to make the program better. The survey should take about 7 minutes. RISKS OF TAKING PART IN THE STUDY Being in this survey has minimal risks for you. COSTS AND FINANCIAL RISKS There are no costs for being in the survey. POSSIBLE BENEFITS OF TAKING PART IN THE STUDY Being in this survey will help improve farmers markets and the Health Bucks program. This could bring more cheap, healthy foods to your area. COMPENSATION You will get a round trip MetroCard (worth $4.50) for being in the survey. DATA SECURITY Information collected as part of this survey will be maintained in a secure manner. Protections will be in place to safeguard your response to the maximum extent allowed by law. We will not ask your name, address, or phone number. We will keep forms in a secure, locked room at Abt Associates. We will enter your answers into a computer file. We will store the file with a password on a secure server at Abt Associates. We will only report your answers combined with answers from 2,000 other surveys. We will destroy all surveys at the end of the study. TAKING PART IS VOLUNTARY You can choose not to fill out the survey. If you do not fill out the survey, there will be no penalty. Even if you agree to fill out the survey, you do not have to answer all the questions. Your choice will not change your relationship with the CDC, the NYC Department of Health, or the Farmers Market Federation of New York. QUESTIONS You may call Lauren Olsho of Abt Associates Inc. ( ) to learn more. You may also call Teresa Doksum, IRB Administrator ( ), if you have other questions about your rights as part of this study. Calling these numbers will incur a toll.

67 ID: NYC HEALTH BUCKS EVALUATION CONSUMER (POINT-OF-PURCHASE) SURVEY Form Approved OMB No.: Exp. Date: 07/31/2011 *Interviewer Name: *Date of Interview: *Farmers Market Name: *Health Buck Market Yes No *Farmers Market Location: BX BKLYN MHT QNS SI INSTRUCTIONS TO INTERVIEWER: [READ TO RECRUIT] Hello - Did you buy something at the market today? [IF YES:] Do you have 5 minutes to answer some questions about your shopping experience? [IF NO:] Are you planning to buy something at the market today? If you are planning on buying something at the market today, please stop by on your way out to take a brief survey. [ASK TO DETERMINE ELIGIBILITY] Before we begin, may I ask if you are 18 or over? [IF NO:] Thank you for your time, but I cannot administer the survey to anyone under 18. Sorry, and have a great day! [IF YES:] You are eligible to participate in this survey. Before we begin, I m going to read this form to you to explain a little bit more about the study and how this survey fits in. READ CONSENT: Congratulations! You qualify for our study. I d like to explain what the study is about before I ask you any other questions. The purpose of this study is to learn about the effects of a farmers market coupon program, called NYC Health Bucks, on fruit and vegetable consumption in certain neighborhoods in New York. As part of our study, we are talking to people who shop at New York City farmers markets to learn about their fruit and vegetable consumption habits and awareness of the Health Bucks program. You will be given a round-trip MetroCard to compensate you for your time. Information collected in this survey will be maintained in a secure manner. There are no costs for participating in this survey. Participation in this survey is voluntary. Even if you agree to participate, you are not required to answer all the questions. You may stop this survey at any time without penalty. Do you have any questions about this study, or may I begin now? [IF YES, REFER TO FREQUENTLY ASKED QUESTIONS AND ASK AGAIN] [IF NO, BEGIN SURVEY] Public reporting burden of this collection of information is estimated to average 7 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA ( ). 2

68 1. During the farmers market season (July 1 through November 15), how often do you shop at a farmers market? [READ CHOICES] 1... More than Once a Week 2... About Once a Week 3... Once or Twice a Month 4... About Once a Month 5... Less Than Once a Month 6... (VOL) Not Sure/Refused 2. Which of the following items did you buy at the farmers market today? [READ LIST AND CIRCLE ALL THAT APPLY.] 1... Fruits 2... Vegetables 3... Jams/Juices 4... Bread 5... Cheese 6... Meats/Fish 7... Baked Goods 8... Other 9... (VOL) Not Sure/Refused 3. How did you pay for your items at the market today? Look at this list*, and as I read each option, tell me if you used it or not. [*Show Card #1. READ LIST AND CIRCLE ALL THAT APPLY.] 1... Cash 2... Debit or Credit Card (like MasterCard, Visa) 3... Food Stamps (a.k.a. Supplemental Nutrition Assistance Program SNAP, or Electronic Benefit Transfer EBT Benefits, or EBT Tokens) 4... WIC or Senior Farmers Market Nutrition Program (FMNP) Coupons 5... WIC Vouchers (a.k.a. Women, Infants, and Children (WIC) Fruit & Vegetable Checks) 6... Health Bucks 7... Other 8... (VOL) Not Sure/Refused 4. Did you notice if any of the following nutrition activities or materials were offered at the market today? [READ LIST AND CIRCLE ALL THAT APPLY.] 1... Cooking Demonstrations 2... Educational Handouts 3... Flyers or Brochures 4... Taste Test/Samples 5... Recipes 6... Other 7... (VOL) Not Sure/Refused 3

69 5. If you were to walk from your home to this particular farmers market, how long would it take you to get here? 1... Less than 5 Minutes to 10 Minutes 3... More than 10 Minutes 4... (VOL) Not Sure/Refused 6. Not including this market, think about the closest location to your home where you can purchase fresh fruits and vegetables. What type of location is this? [READ LIST AS NEEDED.] 1... Supermarket or Grocery Store 2... Convenience/Corner Store 3... Bodega 4... Other Farmer s Market 5... Fresh Fruit & Vegetable Stand or Cart 6... Other 7... (VOL) Not Sure/Refused 7. If you were to walk from your home to that location, how long would it take you to get there? 1... Less than 5 Minutes to 10 Minutes 3... More than 10 Minutes 4... (VOL) Not Sure/Refused [INTERVIEWER: ASK Q8 15 IF MARKET ACCEPTS HEALTH BUCKS.] [READ:] Health Bucks are $2 coupons provided for the purchase of fresh fruits and vegetables at certain farmers markets in New York City. This is what a Health Buck looks like. [SHOW CARD #1] 8. Have you ever seen or heard about Health Bucks before today? 1... Yes 2... No [SKIP TO Q16] 3... (VOL) Not Sure [SKIP TO Q16] 4... (VOL) Refused [SKIP TO Q16] 9. How did you first hear about Health Bucks? [READ CHOICES AS NEEDED.] 1... Flyer, Brochure, or Other Promotional Handout 2... Poster at the Farmers Market 3... Subway/Bus Advertisement 4... Newspaper 5... Web 6... Mailing Received at Home 7... From Other People (Family, Friends, etc.) 8... From a Local Community Organization (i.e. health/community center, church, food pantry, etc) 9... Saw Them Being Used By Shoppers at the Market Other (VOL) Not Sure/Refused 4

70 10. Have you ever used Health Bucks? 1... Yes 2... No [SKIP TO Q15] 3... Not Sure [SKIP TO Q15] 4... (VOL) Refused [SKIP TO Q15] 11. About how often, on average, do you use Health Bucks? 1... Every Week During Farmers Market Season 2... Every Other Week During Farmers Market Season 3... Every Month During Farmers Market Season 4... Every Other Month During Farmers Market Season 5... Once per Farmers Market Season 6... I have only ever used Health Bucks one time 7... (VOL) Not Sure/Refused 12. Did you use Health Bucks today? 1... Yes 2... No [SKIP TO Q15] 3... Not Sure [SKIP TO Q15] 4... (VOL) Refused [SKIP TO Q15] 13. Where did you get the Health Bucks you used today? [READ LIST AND CIRCLE ALL THAT APPLY.] 1... At the Farmers Market (w/ SNAP or EBT Benefits) 2... At the Farmers Market (as part of a promotion) 3... From a Local Community Organization (i.e. health/community center, church, food pantry, etc.) 4... From a Friend or Relative 5... Other 6... (VOL) Not Sure/Refused 14. When did you get the Health Bucks you used today? [READ LIST AND CIRCLE ALL THAT APPLY.] 1... Today 2... Any Other Day 3... (VOL) Not Sure/Refused 15. How much do you agree with these statements about the Health Bucks program? Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree A. I shop at farmers' markets more often because of Health Bucks B. I buy more at farmers' markets because of Health Bucks C. I spend more in Food Stamps (a.k.a. SNAP or EBT benefits) at farmers' markets because of Health Bucks D. Health Bucks help me to eat more fresh fruits & vegetables NS/ Ref 5

71 [ASK ALL] 16. Thinking about nutrition... How many total servings of fruit and/or vegetables did you eat yesterday? A serving would equal one medium apple, a handful of broccoli, or a cup of carrots. [DO NOT READ.] 0... None (VOL) Not sure/refused 17. Was the amount of fruit and vegetables that you ate yesterday much more than usual, about the same as usual, or much less than usual? 1... Much more than usual 2... About the same as usual 3... Much less than usual 4... (VOL) Not Sure/Refused 18. Compared to one year ago, would you say you are now eating more, less, or the same amount of fruits and vegetables? 1... More 2... Less 3... Same 4... (VOL) Not Sure/Refused 19. What is your age? Years (VOL) Don t Know/Not Sure (VOL) Refused 20. (BY OBSERVATION. ASK IF NEEDED: Are you male or female?) 1... Male 2... Female 3... (VOL) Don t Know/Not Sure 4... (VOL) Refused 21. Are you Hispanic or Latino? 1... Yes 2... No 3... (VOL) Don t Know/Not Sure 4... (VOL) Refused 6

72 [IF (Q21=YES) HISPANIC, READ]: Some people, aside from being Hispanic, also consider themselves to be a member of a racial group. 22. What is your race? I will read five options to you; please select one or more. [READ CHOICES; MULTIPLE RESPONSE.] 1... White 2... Black or African American 3... Asian 4... Native Hawaiian or Other Pacific Islander 5... American Indian or Alaska Native 6... (VOL) Don t Know/Not Sure 7... (VOL) Refused 8... (VOL) Other 23. Including yourself, how many people live in your household? Total # of people (VOL) Don t Know/Not Sure (VOL) Refused 24. How many children under the age of 18 live in your household? # of children (VOL) Don t Know/Not Sure (VOL) Refused 25. The next question is about your combined household income. By household income we mean the combined income from everyone living in the household including even roommates or those on disability income. Can you tell me the annual combined income for your household? [READ CHOICES UNTIL RESPONDENT ANSWERS YES ] 1... Less than $10, Less than $20, Less than $30, Less than $40, Less than $50, Less than $60, Less than $70, $70,000 or more 9... (VOL) Don t Know/Not Sure (VOL) Refused 26. Please indicate which of the following programs you or someone in your household currently participates in. [READ LIST AND CIRCLE ALL THAT APPLY.] 1... Food Stamps (a.k.a. SNAP or EBT Benefits) 2... WIC 3... WIC Farmers Market Nutrition Program (FMNP) 4... Senior Farmers Market Nutrition Program (SFMNP) 5... None of the Above 6... (VOL) Don t Know/Not Sure 7... (VOL) Refused 27. Please specify your zip code of residence: Zip Code THANK PARTICIPANT FOR TAKING THE SURVEY, AND HAND OUT FREE METRO CARD. 7

84 ABOUT THIS STUDY You are being asked to fill out a survey of New York City farmers market vendors. We want to learn your thoughts about farmers markets. We also want to learn what you think about the New York City Health Bucks program. This program gives out $2 coupons called Health Bucks. Shoppers can use Health Bucks to buy fresh fruits and vegetables in some New York City farmers markets. The Farmers Market Federation of New York runs this program for the NYC Department of Health. Abt Associates, Inc., a research firm, is studying the Health Bucks program for the Centers for Disease Control and Prevention (CDC). We will use your answers to learn how this program affects New York City farmers markets. We will also learn how to make the program better. The survey should take about 7 minutes. RISKS OF TAKING PART IN THE STUDY Filling out this survey has minimal risks for you. The main risk is that your response to this survey could be disclosed in a way that identifies you; however, many procedures are in place to lower this risk. COSTS AND FINANCIAL RISKS There are no costs for filling out the survey. POSSIBLE BENEFITS OF TAKING PART IN THE STUDY Filling out this survey will help improve New York City farmers markets and the Health Bucks program. This could increase your sales. DATA SECURITY Information collected as part of this survey will be maintained in a secure manner. Protections will be in place to safeguard your response to the maximum extent allowed by law. We will collect the name of the business that runs your stand on a cover sheet. This will be used only to track who has filled out a survey. We will keep cover sheets apart from the rest of the survey. We will store surveys and cover sheets in secure, locked rooms at Abt Associates. We will enter your answers into a computer file. We will store the file with a password on a secure server at Abt Associates. We will only report your answers combined with answers from 450 other surveys. We will not share your answers with CDC, the NYC Department of Health, or the Farmers Market Federation of New York. Your business name will not be in any published reports. We will destroy all surveys and cover sheets at the end of the study. TAKING PART IS VOLUNTARY You can choose not to fill out the survey. If you do not fill out the survey, there will be no penalty. Even if you agree to fill out the survey, you do not have to answer all the questions. Your choice will not change your relationship with CDC, the NYC Department of Health, or the Farmers Market Federation of New York. QUESTIONS You may call Lauren Olsho of Abt Associates Inc. ( ) to learn more. You may also call Teresa Doksum, IRB Administrator ( ), if you have other questions about your rights as part of this study. Calling these numbers will incur a toll.

87 ID: NYC HEALTH BUCKS EVALUATION FARMERS MARKET VENDOR/FARMER SURVEY NYC HEALTH BUCKS EVALUATION FARMERS MARKET VENDOR/FARMER SURVEY Dear Farmer, Health Bucks is a program of the New York City Department of Health designed to improve access to fresh fruits and vegetables in underserved neighborhoods while supporting local growers by providing $2 coupons good for the purchase of fruits and vegetables at participating farmers markets. Abt Associates Inc., a research consulting firm, and its subsidiary Abt SRBI, are carrying out the evaluation of the Health Bucks program, which is sponsored by the Centers for Disease Control and Prevention (CDC). As part of this evaluation, we are surveying farmers who operate stands or stalls in farmers markets throughout New York City, regardless of participation in the Health Bucks program, in order to better understand how accepting different forms of payment, including Health Bucks, may affect market sales and operations. You have been selected to participate in this evaluation. Thank you for taking the time to complete this survey. Please be assured that information collected as part of this survey will be maintained in a secure manner. Your individual responses will be viewed only by researchers at Abt and Abt SRBI; only summary reports combining your responses with those of about 450 other farmers will be shared with the CDC, the NYC Department of Health, or the Farmers Market Federation of New York (FMFNY). Throughout this survey, please feel free to confer with others who have a role in operating your stand or stall for assistance with particular questions, if necessary. The name of the farmers market where we handed out this survey is: Please start by answering the questions below. 1. Date survey filled out: 2. Name of the farm or business that operates your stand or stall at this farmers market: 3. Are you an owner (or part-owner) of the farm or business that operates this stand or stall? Yes No Public reporting burden of this collection of information is estimated to average 7 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA ( ). 2

89 ID: [ID] FARMERS MARKET VENDOR/FARMER SURVEY I. About You and Your Farm or Business First, please provide some information about yourself and the farm or business that operates the stand or stall at the farmers market where we handed out this survey (listed on page 1). 4. Do you ever work at a New York City farmers market stand or stall operated by a different farm or business than the one that operates this stand or stall? Yes No 5. Besides this stand or stall, does this farm or business operate a stand or stall at any other farmers markets in New York City? If so, please fill in the number of other farmers markets (not including the market named on page 1) where this farm or business operates a stand or stall. Yes. Number of other New York City farmers markets: No, this farm or business does not operate a stand or stall at any other New York City farmers markets Don t know/not Sure 6. Is this the first year that this farm or business has operated a stand or stall at this farmers market where we handed out this survey? Yes No Don t know/not Sure 7. Is this the first year that this farm or business has operated a stand or stall at any farmers market? Yes No Don t know/not Sure 8. We are interested in knowing how you decide whether or not to participate in a farmers market. How does each of the following characteristics influence your decision to work at or operate a stand or stall at a specific farmers market? (Circle one number for each item.) Farmers market characteristic Less likely to sell/ Neither operate Neither more nor less likely More likely to sell/ operate Not sure/ don t know a. Operates on weekdays b. Operates on weekends c. Large number of stands/vendors d. Lots of vendor rules & regulations e. New market established this year f. Engages in active outreach or promotion in community g. High fees to sell at market h. Conducts cooking demonstrations or other nutrition education activities i. Located in upscale/high-income neighborhood j. Accepts Food Stamps/EBT benefits k. Participates in Health Bucks program

90 II. About Your Stand or Stall at This Market 9. Please check all months in which your stand or stall has been or will be in operation at this farmers market during the current 2010 farmers market season: (Please check all that apply.) January April July October February May August November March June September December 10. What types of products do you sell at your stand or stall at this farmers market? Please check off all types of products that you have sold or plan to sell at any time during the current 2010 farmers market season even if you are not selling this type of product at your stand or stall today. (Please check all that apply.) Fruits Vegetables Jams/Juices Bread Cheese Meats/Fish III. Paying for Items at Your Stand or Stall Baked Goods Other type of product, Please specify: 11. The pictures on the included Payment Sheet show some common forms of payment that customers can use to pay at New York City farmers markets. Looking at this list, please indicate all forms of payment that customers can currently use to pay at your stand or stall at this particular market. (Please check all that apply.) Cash Debit or credit card (like MasterCard, Visa) Food Stamps (a.k.a. SNAP or EBT benefits or EBT tokens) WIC or Senior FMNP Coupons 3 WIC Vouchers (a.k.a. WIC Fruit & Vegetable Checks) Health Bucks Other form of payment, Please specify: 12. If you did NOT check Health Bucks in question 11, please indicate why you do not accept Health Bucks at your stand or stall at this market. (Please check all reasons that apply.) I do not know about the Health Bucks program. This farmers market does not participate in the Health Bucks program. I do not sell fresh fruits or vegetables at my stand or stall. Too much trouble to get reimbursed for Health Bucks. Some other reason, Please specify: 13. If you did NOT check Health Bucks in question 11, do you accept Health Bucks at any farmers market where you work or operate a stand or stall? Yes (Please proceed to next section.) No (Please STOP filling out the survey here. Thank you for your time!)

91 IV. About Health Bucks 14. Please tell us more about how accepting Health Bucks influences your sales and operations. For each of the following statements, indicate the extent to which you agree or disagree. (Circle one number for each item.) Because I accept Health Bucks Strongly disagree Neither Somewhat agree nor disagree Neither disagree Somewhat agree Strongly agree Don t know/ not sure a. I sell more fresh fruits or vegetables b. I make more money at the market c. my stand or stall has a greater variety of items to sell d. new customers shop at my stand or stall more often e. my stand or stall at this market has expanded f. my customers are more likely to make cash purchases g. customer traffic at my stand or stall moves slower h. I need more staff to help operate my stand or stall i. I have more repeat customers j. I am able to participate in more farmers markets k. my customers buy more new or unfamiliar foods CONTINUED ON NEXT PAGE 4

92 IV. About Health Bucks (Continued) 15. Lastly, we d like to know more about your experiences in accepting and getting reimbursed for Health Bucks this year. How much do you agree or disagree with each of the following statements? (Circle one number for each item.) Strongly disagree Neither Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Don t know/ not sure a. The rules about what customers can purchase with Health Bucks are confusing b. It is easy to get reimbursed for Health Bucks c. If I have a question about Health Bucks, I know who to ask d. I get reimbursed for Health Bucks in a timely fashion Is there anything else you d like to share with us about your experiences with the Health Bucks program? THANK YOU FOR COMPLETING THE SURVEY! 5

101 ABOUT THIS STUDY You are being asked to fill out a survey of New York City farmers market managers. We want to learn your thoughts about farmers markets. We also want to learn what you think about the New York City Health Bucks program. This program gives out $2 coupons called Health Bucks. Shoppers can use Health Bucks to buy fresh fruits and vegetables in some New York City farmers markets. The Farmers Market Federation of New York runs this program for the NYC Department of Health. Abt Associates, Inc., a research firm, is studying the Health Bucks program for the Centers for Disease Control and Prevention (CDC). We will use your answers to learn how this program affects New York City farmers markets. We will also learn how to make the program better. The survey should take about 8 minutes. RISKS OF TAKING PART IN THE STUDY Filling out this survey has minimal risks for you. The main risk is that your response to this survey could be disclosed in a way that identifies you; however, many procedures are in place to lower this risk. COSTS AND FINANCIAL RISKS There are no costs for filling out the survey. POSSIBLE BENEFITS OF TAKING PART IN THE STUDY Filling out this survey will help improve farmers markets and the Health Bucks program. This could increase your market s sales. DATA SECURITY Information collected as part of this survey will be maintained in a secure manner. Protections will be in place to safeguard your response to the maximum extent allowed by law. We will collect your name and your farmers market name on a cover sheet. This will be used only to track who has filled out a survey. We will keep cover sheets apart from the rest of the survey. We will store surveys and cover sheets in secure, locked rooms at Abt Associates. We will enter your answers into a computer file. We will store the file with a password on a secure server at Abt Associates. We will only report your answers combined with answers from 90 other surveys. We will not share your answers with CDC, the NYC Department of Health, or the Farmers Market Federation of New York. We will destroy all surveys and cover sheets at the end of the study. TAKING PART IS VOLUNTARY You can choose not to fill out the survey. If you do not fill out the survey, there will be no penalty. Even if you agree to fill out the survey, you do not have to answer all the questions. Your choice will not change your relationship with CDC, the NYC Department of Health, or the Farmers Market Federation of New York. QUESTIONS You may call Lauren Olsho of Abt Associates Inc. ( ) to learn more. You may also call Teresa Doksum, IRB Administrator ( ), if you have other questions about your rights as part of this study. Calling these numbers will incur a toll.

102 Health Bucks Evaluation Manager Survey Invitation Letter

103 [Date] [Name] Market Manager [Market Name] [Market Address] Dear [Manager Name], We are writing to ask you to complete a short survey about your experiences as a farmers market manager, and to inform you that we plan to visit [Market Name] as part of an important study about preventing childhood obesity. This study is sponsored by the Centers for Disease Control and Prevention (CDC), and includes an evaluation of the New York City Health Bucks program. As you may know, the Health Bucks program provides $2 coupons to buy fresh fruits and vegetables at participating farmers markets in New York City. Markets that participate in the Health Bucks program as well as those that do not are being included in this important project to learn about the impact this program is having in the City. The CDC has contracted us at Abt Associates to conduct this evaluation, and we are working in full cooperation with the NYC Department of Health and Mental Hygiene (DOHMH) and the Farmers Market Federation of New York (FMFNY) to obtain accurate information about farmers markets and to make sure that our activities do not disrupt normal market operations. Please fill out the attached survey and mail it back to us using the enclosed postage-paid envelope as soon as possible. (If you have already completed this survey in-person with us while we were at your market, please disregard this mailing.) Additional information about the survey can be found on the survey itself and the enclosed fact sheet. We are planning to visit [Market Name] on [Date] and [Date] to conduct brief surveys with vendors and shoppers. If these dates are not convenient for your market, please contact Tara Merry at Abt SRBI by phone at or by at to arrange alternative dates for a visit. What exactly will we be doing at your market? We plan to visit each selected market twice this season. During our visits, researchers will conduct brief survey interviews with shoppers and vendors. Teams of two to four researchers will visit for about three hours each time to conduct these surveys in-person. It is our priority to minimize disruptions to farmers market operations during our visits. Teams will introduce themselves to you upon arrival and find a place to set up near the market entrance or exit that will not interfere with normal customer traffic. Shoppers will only be approached after they are done shopping. The survey takes about 7 minutes and a round-trip MetroCard will be provided to those who complete the survey. Vendors will only be approached during down times when they are not busy with customers. If vendors are too busy to complete the survey during our visit, a copy can be left for them to fill out and mail back later. The survey takes about 7 minutes to complete.

104 Survey participants will be informed that their participation is voluntary. Fact sheets with information about the study and contact phone numbers will be provided for reporting questions or problems. This study has been reviewed and approved by the Abt Associates IRB to ensure that it adheres to ethical standards for research. In July, we sent the operator of the [Market Name] a similar letter about our study with instructions on how to opt-out if they did not want their market to participate. We are only contacting managers of markets that did not opt-out of participating in this important study. If your market operator did not receive a letter about this study, a copy can be obtained by contacting Lauren Olsho at Abt Associates. The operator can also contact Lauren Olsho to request their market to be excluded from participating in the study. If you have any questions or concerns about our planned market visits or the study overall, please contact one of the individuals below. Abt Associates Health Bucks Evaluation Lead Researcher Lauren Olsho Abt SRBI Health Bucks Survey Project Director Tara Merry Sincerely, Lauren Olsho Health Bucks Evaluation Lead Researcher

105 Health Bucks Evaluation Manager Survey 1

106 ID: NYC HEALTH BUCKS EVALUATION FARMERS MARKET MANAGER SURVEY Dear Market Manager, Health Bucks is a program of the New York City Department of Health designed to improve access to fresh fruits and vegetables in underserved neighborhoods while supporting local growers by providing $2 coupons good for the purchase of fruits and vegetables at participating farmers markets. Abt Associates Inc., a research consulting firm, and its subsidiary Abt SRBI, are carrying out the evaluation of the Health Bucks program, which is sponsored by the Centers for Disease Control and Prevention (CDC). As part of this evaluation, we are surveying farmers market managers throughout New York City, regardless of participation in the Health Bucks program, in order to better understand how accepting different forms of payment, including Health Bucks, may affect market sales and operations. You have been selected to participate in this evaluation. Thank you for taking the time to complete this survey. Please be assured that information collected as part of this survey will be maintained in a secure manner. Your individual responses will be viewed only by researchers at Abt and Abt SRBI; only summary reports combining your responses with those of about 90 other market managers will be shared with the CDC, the NYC Department of Health, or the Farmers Market Federation of New York (FMFNY). Throughout this survey, please feel free to confer with others who have a role in operating this market for assistance with particular questions, if necessary. When you have completed the attached survey, please mail it back to us using the enclosed postage-paid envelope. Please start by answering the questions below. 1. Name of the farmers market you manage (please confirm): [MARKET NAME] 2. Your name: Public reporting burden of this collection of information is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA ( ). 3

108 ID: [ID] FARMERS MARKET MANAGER SURVEY I. About You and Your Market First, we would like to collect some basic information about you and the market you manage. 3. Date survey filled out: 4. Please fill in the name of the organization that sponsors this market: 5. We d like to know more about the mission of this sponsoring organization. Which of the following goals are included in the organization s mission? (Please check all that apply.) Improving access to nutritious foods in underserved neighborhoods or populations. Supporting local growers and agricultural producers. Educating consumers about the benefits of locally-grown foods. Fostering opportunities for social gathering and interaction. Boosting the local economy. Other goal. Please specify: 6. On an average day, about how many different vendors operate stands or stalls at this market? If you are not sure, please fill in your best guess. a. Average number of vendors on weekends: (Or check here if market does not operate on weekends... ) b. Average number of vendors on weekdays: (Or check here if market does not operate on weekdays... ) 7. On an average day, about how many customers would you say shop at this farmers market? Again, if you are not sure, please fill in your best guess. a. Average number of customers on weekends: (Or check here if market does not operate on weekends... ) b. Average number of customers on weekdays: (Or check here if market does not operate on weekdays... ) 8. Does this farmers market offer any of the following nutrition activities or materials? (Please check all that apply.) Cooking demonstrations Educational handouts Flyers or brochures Taste tests/samples Recipes Other activities or materials Please specify: 2

109 I. About You and Your Market (Continued) 9. The pictures on the included Payment Sheet show some common forms of payment that customers can use to pay at New York City farmers markets. Looking at the list below, please check all forms of payment that customers can currently use to pay at this farmers market. (Please check all that apply.) Cash Debit or credit card (like MasterCard, Visa) Food Stamps (a.k.a. SNAP or EBT benefits or EBT tokens) WIC or Senior FMNP Coupons WIC Vouchers (a.k.a. WIC Fruit & Vegetable Checks) Health Bucks Other form of payment. Please specify: 10. If you did NOT check Food Stamps in question 9, please indicate why you do not accept Food Stamps at this farmers market. (Please check all reasons that apply.) Wireless EBT terminal is too expensive. Not enough staff to operate EBT terminal and/or distribute EBT tokens. Not enough Food Stamp/EBT customers in this neighborhood. Vendors at this farmers market do not wish to accept Food Stamps. Other reason. Please specify: 11. If you did NOT check Health Bucks in question 9, please indicate why you do not accept Health Bucks at this farmers market. (Please check all reasons that apply.) I do not know about the Health Bucks program. The Health Bucks program is not available in neighborhood where this market is located. Vendors at this farmers market do not wish to accept Health Bucks. Some other reason. Please specify: II. Food Stamps/ EBT Benefits at Your Market Please fill out this section only if you indicated in question 9 that this farmers market accepts Food Stamps (a.k.a. SNAP or EBT benefits or EBT tokens). If this farmers market does NOT accept Food Stamps, please skip to section III on the next page. 12. Are you responsible for managing or coordinating the EBT program (a.k.a. Food Stamps/SNAP benefits) for this market? Yes No 13. How does your market promote your EBT program to Food Stamp participants in your community? (Please check all that apply.) Flyers, brochures, or other promotional handouts Posters at the farmers market Subway/bus advertisements Newspaper ads or articles Website or online ads Mailings to neighborhood residents Partnerships with organizations in the community In-person outreach at community locations Other activities or materials. Please specify: 3

110 II. Food Stamps/ EBT Benefits at Your Market (Continued) 14. Please tell us more about how accepting Food Stamps or EBT Benefits influences sales and operations at your farmers market. For each of the following statements, indicate the extent to which you agree or disagree. (Circle one number for each item.) Because this farmers market accepts Food Stamps a. more vendors want to operate stands or stalls at this market... b. dealing with market customers is more time-consuming... c. I do not have enough staff to help the market run efficiently... d. new customers shop at this market more often... e. customers at this market are more likely to make cash purchases... Strongly disagree Somewhat disagree Neither agree nor Neither disagree Somewhat agree Strongly agree Don t know/ not sure f. market traffic moves less smoothly g. more repeat customers come to this market III. Health Bucks Participation Please fill out this section only if you indicated in question 9 that this farmers market accepts Health Bucks from customers as a form of payment. If this farmers market does NOT accept Health Bucks, you are finished! Thank you for completing this survey. 15. How does your market promote the Health Bucks program in your community? (Please check all that apply.) Flyers, brochures, or other promotional handouts Posters at the farmers market Subway/bus advertisements Newspaper ads or articles Website or online ads Mailings to neighborhood residents Partnerships with organizations in the community In-person outreach at community locations Other activities or materials Please specify: 4 CONTINUED ON NEXT PAGE

111 III. Health Bucks Participation (Continued) 16. Please tell us more about how participating in the Health Bucks program influences sales and operations at your farmers market. For each of the following statements, indicate the extent to which you agree or disagree. (Circle one number for each item.) Because this farmers market participates in the Health Bucks program Strongly disagree Somewhat disagree Neither agree nor Neither disagree Somewhat agree Strongly agree Don t know/ not sure a. more vendors want to operate stands or stalls at this market b. dealing with market customers is more time-consuming c. I do not have enough staff to help the market run efficiently d. new customers shop at this market more often e. customers at this market are more likely to make purchases using their Food Stamp/EBT benefits f. customers at this market are more likely to make cash purchases g. market traffic moves less smoothly h. more repeat customers come to this market You indicated above that your market accepts Health Bucks as a form of payment for fresh fruits and vegetables. Is this market also currently distributing Health Bucks to customers using their EBT benefits at the market? Yes No 18. If this market is NOT currently distributing Health Bucks to customers, please indicate why not. (Please check all reasons that apply.) This market does not have an EBT machine. Too much trouble to distribute Health Bucks. Not enough staff to distribute Health Bucks. Not enough Food Stamp/EBT customers in this neighborhood. Some other reason. Please specify: Ran out of Health Bucks. 19. Is there anything else you d like to share with us about your experiences with the Health Bucks program? THANK YOU FOR COMPLETING THE SURVEY! 5

112 Health Bucks Evaluation Consumer Organization Survey Invitation

113 SUBJ: Health Bucks End-Of-Year Survey Dear [FullName], As we near the end of this farmer s market season, I am writing to ask for your participation in the Health Bucks End-Of-Year Survey. All community organizations that received Health Bucks this year are being asked to share their experiences with and opinions of the program. The online survey should take approximately 10 minutes to complete. You are being contacted because the New York City Department of Health and Mental Hygiene (DOHMH) provided your information as the main contact from [ORGANIZATION] for Health Bucks. If you were not involved in the distribution of Health Bucks for [ORGANIZATION], you will be able to provide contact information for the appropriate person by clicking on the survey link below. To begin the survey, please click on the link below or copy and paste the entire link into your Internet browser: [LINK]. If you have any problems accessing the survey, please send an to and we will get back to you. About the Survey This survey is being conducted as part of an evaluation of the New York City Health Bucks Program. This study is sponsored by the Centers for Disease Control and Prevention (CDC), and is being conducted by Abt Associates and Abt SRBI. We are working in full cooperation with the NYC Department of Health and Mental Hygiene (DOHMH) and the Farmers Market Federation of New York (FMFNY) to obtain accurate information about how the Health Bucks program affects community organizations. Your responses will also be used by the NYC Department of Health to learn how community organizations make use of Health Bucks and how to make the program better. If you have any questions about the survey, please contact Tara Merry of Abt SRBI ( ) or Lauren Olsho of Abt Associates, Inc. ( ). Sincerely, Tara Merry Health Bucks Survey Project Director Abt SRBI Inc. does not send unsolicited messages. You have received this message because either you, or someone else using this address, has agreed to be contacted. To be removed from participation in this study, simply send an with the word "Remove" in the subject line to:

114 Health Bucks Evaluation Community Organization Survey

115 Subject ID: Form Approved OMB No.: Exp. Date: 07/31/2011 NYC HEALTH BUCKS EVALUATION COMMUNITY ORGANIZATION SURVEY QUESTIONS (FOR WEB SURVEY) READ-IN FROM SAMPLE [PRE-POPULATED FROM ADMIN DATA]: Name of Organization/Program: Neighborhood(s) Served: Name and Title of Person Completing Survey: Address: Phone Number: You are being invited to take part in a survey that is being conducted as part of the evaluation of the New York City Health Bucks program. The survey will take about 10 minutes to complete. SCREENER: S1. Are you the individual (or one of the individuals) who was responsible for managing the distribution of Health Bucks for [COMMUNITY ORG NAME] this year? Yes No IF NO: S2. This survey should be completed by someone at [COMMUNITY ORG] who managed the distribution of Health Bucks for your organization this year. Please provide the name and contact information for someone who managed the distribution of Health Bucks for your organization. Name: Title: Address Phone Number We will contact this person directly. Thank you for your time! Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA ( ). 2

116 Subject ID: CONSENT [IN PRINTABLE FORMAT]: Please read the following information about this survey before you begin. INTRODUCTION The New York City Health Bucks program gives out $2 coupons called Health Bucks, which shoppers can use to buy fresh fruits and vegetables in farmers markets in some New York City neighborhoods. Abt Associates Inc., a research consulting firm, is evaluating the Health Bucks program for the Centers for Disease Control and Prevention (CDC). As part of the evaluation, web-based surveys are being conducted with all community organizations that participated in the Health Bucks program, in order to help us understand your experiences with and opinions of the program this year. Your responses will also be used by the NYC Department of Health for tracking and planning purposes for the Health Bucks program. RISKS OF TAKING PART IN THE STUDY Completing this survey represents minimal risk to you and your organization. The primary risk is that your response to this survey could be disclosed in a way that identifies you or your organization; however, many procedures are in place to minimize this risk. POSSIBLE BENEFITS OF TAKING PART IN THE STUDY By completing this survey, you are helping us to understand how the Health Bucks program can be improved, and how programs like this might work in other communities. Lessons we learn from your responses will help to improve the program next year. DATA SECURITY Information collected as part of this survey will be maintained in a secure manner. Protections will be in place to safeguard your response to the maximum extent allowed by law. Your answers will be stored electronically in a secure location. Study researchers at Abt Associates, Inc., and the Health Bucks program staff at the NYC Department of Health will have designated access to study information for analysis purposes. Although CDC is sponsoring the study, the analysis plan does not call for sharing identifiable information with CDC, only information in summary form. For reporting and publication purposes, we plan to combine the comments and responses you give on the survey with the responses of about 200 other organizations. PARTICIPATION IS VOLUNTARY If you decide to participate in the survey, you will not be penalized in any way now or in the future based on your responses. Even if you agree to participate, you are not required to answer all the questions. In addition, a decision not to participate will not affect your relationship with CDC or the NYC Department of Health now or in the future. QUESTIONS You may call Lauren Olsho of Abt Associates Inc. ( ) or her at to obtain more information. You may also call Teresa Doksum, IRB Administrator ( ) if you have other questions about your rights as a participant in this evaluation. Please note that calling these numbers will incur a toll. 3

117 Subject ID: [INSERT PAGE BREAK HERE] STATEMENT BY PERSON COMPLETING THE SURVEY By completing this survey, I agree that I have read and understand the previous information. I have had all my questions answered fully and I freely and voluntarily choose to participate in the survey. 4

118 Subject ID: I. Applying for Health Bucks First are some questions about the Health Buck application process. 1. How did your organization first hear about Health Bucks? (Select one option.) Direct communication ( , phone call, mailing, flyer, in-person visit) from the District Public Health Office or the NYC Department of Health Another community organization that distributes Health Bucks Posters or other advertisements Newspaper ads or articles NYC Department of Health website Your organization s clients or prior Health Bucks participants Some other way: Prefer not to answer 2. Which of the following are reasons you wanted to distribute Health Bucks to recipients this year? (Check all that apply, and also choose the one reason you considered most important.) [MOST IMPORTANT OPTION TO BE INDICATED BY RADIO BOX; OTHER REASONS INDICATED BY CHECKBOXES As an incentive to enroll in food stamps As an incentive to participate in a nutrition workshop or class As an incentive to participate in a non-nutrition workshop or class To encourage shopping at farmers markets To increase consumption of fruits and vegetables For use in outreach activities with our target population To supplement other farmers market coupons (e.g. WIC FMNP, cash or other supplements provided by your organization) Some other reason: Prefer not to answer 3, Which of the following types of nutrition education or promotion activities did your organization provide in 2010? (Please check all that apply.) [EXPLANATION OF NUTRITION EDUCATION OR PROMOTION ACTIVITIES ]: (Nutrition education or promotion activities are programming that educate community members about nutrition, encourage community members to improve their nutrition, and/or provide community members with tools or resources to eat more healthful foods.) One-time nutrition education workshops or classes Ongoing nutrition education classes Nutrition or health events, such as health fairs Organized trip to farmers market One-on-one nutrition counseling Other: OR [MUTUALLY EXCLUSIVE] None of the above we did not provide nutrition education or promotion activities. OR [MUTUALLY EXCLUSIVE] Prefer not to answer 5

119 Subject ID: 4. How easy or difficult was it for your organization to apply for Health Bucks this year? (Select one option.) Very easy Somewhat easy Neither easy nor difficult Somewhat difficult Very difficult Prefer not to answer [IF RESPONDENT SELECTS SOMEWHAT OR VERY DIFFICULT IN Q4] 4a. What specifically made the Health Bucks application process difficult? [OPEN-END] Prefer not to answer II. Distributing Health Bucks The next questions are about how you distributed Health Bucks. 5. In which of the following neighborhoods or boroughs did you distribute Health Bucks this year? (Please check all that apply) The Bronx Brooklyn Harlem Prefer not to answer 6. During which of the following months this year (2010) did you receive Health Bucks from your District Public Health Office? (Please check all that apply) January February March April May June July August September October November Don t Know Prefer not to answer 7. During which of the following months this year (2010) did you distribute Health Bucks to recipients? (Please check all that apply) [LIST ONLY MONTHS EQUAL OR LATER THAN FIRST RECEIVED HBs IN Q5] January February March April May June July August September October November Don t Know 6

120 Subject ID: Prefer not to answer 8. After you received your Health Bucks this year, did you: Distribute them mostly all at once, or Keep some to distribute throughout the farmers market season? Other (Please specify: ) Prefer not to answer 9. About how many of the Health Bucks you received in 2010 did you distribute? All More than half, but not all About half Some, but less than half None Don t know Prefer not to answer [IF ANY CHECKBOX OTHER THAN ALL DK/REF IS SELECTED IN Q9] 9a. Why were you unable to distribute all of your Health Bucks? (please check all that apply) Health Bucks received too early in the year Health Bucks received too late in the year Clients did not want Health Bucks Clients did not know what Health Bucks were Forgot to distribute Health Bucks Did not have time to distribute Health Bucks Other: Prefer not to answer [LIST EACH CHECKED ACTIVITY IN Q3, OR SKIP TO Q12 IF NONE /PREFER NOT TO ANSWER CHECKED] 10. Did you distribute Health Bucks this year during any of these nutrition education or promotion activities? (Please check yes or no for each activity.) [INCLUDE EXPLANATION OF NUTRITION EDUCATION OR PROMOTION ACTIVITIES FROM QUESTION 3 HERE] Activity [CHECKED ACTIVITY FROM Q3] [CHECKED ACTIVITY FROM Q3] Prefer not to answer Health Bucks distributed? [LIST EACH CHECKED ACTIVITY IN Q3, OR SKIP TO Q12 IF NONE /PREFER NOT TO ANSWER CHECKED] 7

121 Subject ID: 11. For each of the nutrition education or promotion activities your organization offered in 2010, please indicate whether you added, expanded, or made no change as a result of receiving HB to distribute to the community. [INCLUDE EXPLANATION OF NUTRITION EDUCATION OR PROMOTION ACTIVITIES FROM QUESTION 3 HERE] Activity [INSERT CHECKED ACTIVITY FROM Q3] [INSERT CHECKED ACTIVITY FROM Q3] Prefer not to answer Added new activities because of Health Bucks [MUTUALLY EXCLUSIVE] Expanded existing activities because of Health Bucks [MUTUALLY EXCLUSIVE] No, did not make any changes to these activities because of Health Bucks [MUTUALLY EXCLUSIVE] 12. Did you receive as many Health Bucks as you would have liked in 2010? (Select one option.) Yes No Prefer not to answer 13. Who did you distribute Health Bucks to this year? (Check all that apply) Children under 18 Pregnant women Families (children and adults) Seniors age 60 and older Other adults not caring for children at home Other (specify): Prefer not to answer 14. Did your organization have any requirements for recipients to qualify to get Health Bucks this year? (Select one option.) Yes No Prefer not to answer 14b. [IF YES]: Which of the following were requirements to get Health Bucks? (Check all that apply) Participation in the Food Stamp/SNAP program Low income Never or rarely shop at farmers markets High-risk health status (e.g. presence or risk of diabetes or other chronic diseases) 8

122 Subject ID: Pregnant or have children Other: Prefer not to answer 15. Did your organization intentionally distribute Health Bucks this year: Around the same time recipients Food Stamp/SNAP accounts were refilled? (Check one option.) Yes No Not sure Not applicable recipients are not SNAP participants Prefer not to answer When you thought recipients Food Stamp/SNAP balance may be running low? Yes No Not sure Not applicable recipients are not SNAP participants Prefer not to answer 16. What is the highest number of Health Bucks that were given to a single person or household at one time this year? (Your best estimate is fine. Enter highest number) Enter # of Health Bucks Not sure Prefer not to answer 17. What is the highest number of Health Bucks that were given to a single person or household over the course of 2010? (Your best estimate is fine. Enter highest number) Enter # of Health Bucks Not sure Prefer not to answer 9

123 Subject ID: III. Promoting and Tracking Use of Health Bucks The following questions are about how your organization advertized and kept track of Health Bucks. 18. How did your organization advertise Health Bucks to increase awareness about the program this year? (Check all that apply) Brochures or flyers provided by the NYC Department of Health Posters provided by the NYC Department of Health Nutrition workshops or classes Non-nutrition workshops or classes Nutrition or health events, such as health fairs Talking directly to individuals Other: Did not advertise program [ANSWER OPTION MUTUALLY EXCLUSIVE]. Prefer not to answer 19. When you distributed Health Bucks this year, did your organization regularly record any of the following information about recipients? (Check all that apply) Name Age Household size or number of children Household income Overall health status (e.g. presence or risk of diabetes or other chronic diseases) Participation in the Food Stamp/SNAP program Other: No, did not collect information [ANSWER OPTION MUTUALLY EXCLUSIVE] Prefer not to answer 20. After distributing Health Bucks, how often did you follow up with recipients about: If they used their Health Bucks What they bought with Health Bucks Where they used their Health Bucks Their overall satisfaction with Health Bucks program Other: Prefer not to answer Always Sometimes Rarely Never 10

124 Subject ID: 21. How did your organization encourage recipients to use Health Bucks? Handed out NYC Health Department brochures or flyers with Health Bucks Handed out Nutritional information with Health Bucks Provided cooking demonstrations for Health Bucks recipients Organized trips to farmers markets with Health Bucks recipients Discussed Health Bucks in nutrition education workshops or classes Followed up with individual Health Bucks recipients Other: None of the above [ANSWER OPTION MUTUALLY EXCLUSIVE] Prefer not to answer 22. How many recipients do you think used the Health Bucks you gave them? All Most Some None Prefer not to answer 22a. [IF ALL OR MOST]: What do you think was most effective in getting recipients to redeem Health Bucks? [OPEN-END] Prefer not to answer 22b. [IF SOME OR NONE]: Why do you think some recipients did not use them? [OPEN-END] Prefer not to answer IV. Other Questions about Health Bucks To end, there are a few general questions about Health Bucks. 23. During the time your organization was distributing Health Bucks this year, approximately how many hours per week, on average, did organization staff spend on the distribution of Health Bucks and administration of the Health Bucks program? Less than 5 hours 5 to less than 10 hours 10 to less than 15 hours 15 to less than 20 hours 20 to less than 25 hours 25 hours or more Prefer not to answer 11

125 24. If you could change the way your organization distributed Health Bucks or administered the Health Bucks program this year, what would you change? Prefer not to answer 25. How satisfied were you with the Health Bucks program overall? Very satisfied Somewhat satisfied Neither satisfied nor unsatisfied Somewhat unsatisfied Very unsatisfied Prefer not to answer 26. Do you have any additional comments or feedback about the Health Bucks program? Prefer not to answer Thank you for your time. Your participation is appreciated. 12

128 Consumers Focus Groups Discussion Outline Form Approved OMB No.: 0920-xxxx Exp. Date: xx/xx/xxxx Project: Evaluation of Childhood Obesity Prevention and Control Initiative: New York City Health Bucks Program Focus groups with (insert description of type of consumer) Discussion Outline I. Introduction: Welcome (10 minutes) A. Purpose: During the next 2 hours, we will be discussing some of your experiences shopping at farmers markets. B. Disclosure Observation Audio Data Security Voluntary Participation C. Ground Rules Would like to hear from everyone; one at a time No right or wrong answers Moderator is impartial, please be candid Moderator will take you through questions by section Remind participants not to repeat anything heard today or disclose identity of participants. We will take a break after the first hour, but feel free to leave the room if you need a break before that time. If you have a child with you, feel free to leave the room as needed, but do try to come back as soon as possible. Public reporting burden of this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-xxxx).

129 D. Participant Introduction Name (Ask them to introduce themselves by first name only. Advise them that last names will not be recorded if inadvertently disclosed.) Tell us if you learned about this group from doing a survey, seeing the poster, or other (explain) II. Farmers Market Awareness and Attendance (30 minutes) Let s spend some time talking about your experience with farmers markets. 1. How often do you shop at a farmers market? Every week; throughout the season; specific months How long have you shopped at farmers markets? 2. Would you consider yourself a regular farmers market shopper (e.g., you shop at farmers markets consistently during a certain period of time)? 3. Do you consistently shop at one market, a few different markets, or many different markets? What is considered few and many? During the last year or two, have you changed the markets at which you consistently shop? o What are some of the reasons for changing? 4. State some of the reasons why you have chosen to shop at the farmers markets. [Unaided, then probe as necessary.] Convenience what makes a farmers market convenient? (Probe: On my way to/from work/school/child care? How far? Close to home? How far? Close to public transportation? Can drive or ride bike to? No other stores close-by? Other Product Selection/Price What is considered a good selection of products? (Probe: Quality of products or how appealing the products appear? Amount of products or variety (e.g.,fruits and vegetables, meats, baked goods, non-food products, etc.)) How do the prices of products compare to other stores or markets? How much does price matter?

130 Other Benefits/Incentives (Probe: Offer cooking classes or other educational classes? Offer different payment methods? Accepts Food Stamps? Offer and accept Health Bucks (HB)? Aesthetics (neighborhood; environment)? Social aspect? Good customer service/friendly Samples/tastings of products? What benefits/incentives are most important to you? 5. Considering the different reasons you have all mentioned, are there some that matter more than others? 6. Close your eyes and think about the market environment during your most recent visit, List some of the things that made it a pleasant experience for you List some of the things that made it an unpleasant experience for you 7. Are there any reasons you would no longer shop at farmers markets? III. Farmers Market Purchases (10 minutes) 8. What do you generally buy at the market? 9. How do you decide what to buy? Where else do you shop for similar products? Where else could you shop for similar products? How do those other options compare to the farmers market? 10. How do you decide what not to buy? (Probe: quality of product, price of product, type of product (i.e., I never buy fish. ), other?). IV. Payment for Purchases (10 minutes) 11. How do/did you pay for the products you purchase(d) at the market? Is this typically how you pay? If not, what other payment methods do you use? How important is it to have payment options? Are there other forms of payment you would like to use? 12. How convenient was the payment process? What made it easy or difficult?

131 V. Health Bucks (30 minutes) 13. Have you ever seen a Health Buck (show Health Buck)? Where have you seen a Health Buck? 14. Do you know what a Health Buck is? [Note: If you do not know what a Health Buck is, would you be interested in learning more about the program? If so, we can give you some information at the end of our discussion.)] If you know what a Health Buck is, how did you learn or hear about the Health Bucks Program? (Probe: At a farmers market When you got your Electronic Benefit Transfer (EBT) tokens Signage Saw other people using it Participating in a nutritional program/demonstration Other Friend or family, As part of a program or organization that you are a member of (e.g., Women, Infant, and Children (WIC) clinic, church, community center) Any thoughts on how to best let others know about Health Bucks? 15. Have you ever used a Health Buck? How often have you used Health Bucks? (Probe: at each of your farmers market visits; many but not all visits; few visits; only 1-2 visits) If so, where did you get the HB that you used? Farmer s Market o When you got your EBT tokens? o Participating in a nutritional class/demonstration? Community-based organization (CBO) Both Other 16. If you got your Health Buck(s) from a CBO, did you have to do anything to receive the HB? (Probe: participate in any nutrition education or physical activity (e.g, walking group, walk and shopping trip to the Farmer s Market, cooking class). How many Health Bucks coupons did you receive for participating in the activity?

132 17. Thinking of the different ways you receive Health Bucks, is any method (e.g., at a farmers market when getting your EBT tokens or participating in a demonstration or through a CBO) better or preferable? If yes, in what ways (e.g., more convenient, faster, other)? 18. Are there other ways/places in which you would like to receive Health Bucks (e.g., by mail)? Do you receive in any other coupons or incentives in this way? 19. Is there a particular time when you prefer to use your Health Bucks? during the Farmers Market (FM) season (June-November) during a month (e.g., beginning or end) 20. What is important about using the Health Bucks during this particular time of the season, month, or other? (Probe: when you receive a Health Buck, do you usually spend it right away, or save it for use at another time or another market?) 21. Do you typically have enough Health Bucks at the times that you prefer to use them? If yes, what is important about having enough Health Bucks at the right time? If no, what would make it easier for you to get the Health Bucks when you want them? What happens when you don t get the Health Bucks when you need them (e.g., don t buy fruits and vegetables at the FM, don t shop at the FM to buy anything, etc.)? 22. Overall, is the process for getting and using Health Bucks convenient? 23. Is there anything that you would change about the process? 24. When you have used your Health Bucks, what did you purchase with them? Do you use your Health Bucks to purchase new or unusual fruits or vegetables you may not have tried before? 25. Has there been a time when you have had Health Bucks, but not used it/them? What are the reasons for not using the Health Bucks? 26. Is there anything that would influence your willingness to try or use Health Bucks (i.e., makes you more or less likely to use HBs)?

133 VI Consumption (20 minutes) 27. What do you do with the products/fruits and vegetables you purchase at the Farmer s Market? (Probe: use as snacks, serve at meals times, pack lunches for school kids, freeze, can, share with others, other) How do you normally eat fruit you buy at the farmers market? (Probe: fresh; prepared in some way; other) How do you normally eat vegetables you buy at the farmers market? (Probe: fresh; baked; prepared using oil or butter) 28. Who eats the produce you purchased from the Farmer s Market? (Probe: family/friends; adults; kids (what ages); other) 29. Was there an event or any materials at the Farmers Market that gave you information on how to use the products (e.g., cooking demonstration, educational class, pamphlets or hand-outs, etc.)? What did you learn? If both an event and materials were available, do you prefer an event (e.g., demo/class) or written material? Was this connected to the HB program? 30. Do you generally use all of the products you purchase? If yes, how long does it take you to consume the products you purchased? (Probe: few days, week, other) If not, what happened to the products you did not use? (Probe: gave away, spoiled, other). 31. As a final question, thinking about what you have shared about your Farmer s Market experiences, your use of Health Bucks, and how you use the products you purchase at the Farmer s Market, has Health Bucks influenced or changed your behavior in any way? About what you purchase? Please give an example. How you use your purchases? Please give an example. How much you purchased? Any other changes? VI. Conclusion (5 minutes) Check with clients for additional questions. Thank and dismiss participants. Note for participants about signatures for incentive payments and where information about the Health Bucks program is displayed.

134 Health Bucks Evaluation Consumer Focus Group Recruitment Poster

135 Tell us what you think! As part of a study for the Centers for Disease Control and Prevention (CDC), we are holding small group discussions with people who shop at farmers markets and use Health Bucks. We want to hear what you think about farmers markets and Health Bucks. You will receive $35 for coming to a 1.5 hour discussion in your neighborhood. Call for more information! Abt Associates Health Bucks Evaluation Grab a phone number below! Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion Farmers Market Discussion

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